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SOUTHERN MEDICAL 



AXD 



SURGICAL JOURNAL 



Vol. I.] JUNE, 1836. [No. 1. 

INTRODUCTION. 

In commencing the discharge of our editorial duties, it is 
proper that we make some brief observations, explanatory of 
Hie nature and objects of the work we propose, and the motives 
that have induced ss to engage in the undertaking. 

Arguments need not be adduced to prove the great value and 
utility of medical periodicals — their importance, as means of 
collecting and communicating useful information in a condensed 
form, is duly appreciated by the profession in all the enlightened 
nations oftks world,' and nowhere more highly than in the 
United States, to the circumstances and necessities of whose 
physicians they are peculiarly appropriate. Scattered over a 
thinly populated but almost illimitably extended country, in 
which the labours of physicians are most arduous and their 
remuneration inadequate, few individuals can command money 
to purchase or leisure to read a sufficient number of books to 
enable them to keep pace with the improvements that are con- 
stantly made in medicine ; besides, in many remote situations, 
the difficulties in the way of obtaining books are almost insu- 
perable, and new publications become old before they are 
received. 

Whilst European physicians, enjoying superior opportunities 

and facilities for the acquisition of knowledge and the cultivation 

of medicine, generally excel in medical erudition, and are justly 

entitled to the credit of having composed the most learned and 

I borate works, and having made manv of the most important 
1 



13S3 



httrodact \jt\xaz 



and valuable discoveries and improvements in medicine, t 

are nevertheless so actuated by national jealousy and mutual 
animosity, that they not unfrequently refuse to acknowledge 
apply in one nation the most obvious improvements made in 
another, and they arc moreover too much d. to bow d< 

to authority, and yield implicit obedience to the dicta of distin- 
guished men. American physicians, on the contrary, at a happy 
distance from all such illiberal and improper influences, indepen- 
dent of the doctrines or dogmas of any school. una wed by authori- 
ty, lvgardkss of ages, names or nations, obedient only t-> the dic- 
tates of true philosophy, inductive and eclectic, reason for them- 
selves, and, selecting what is good and rejecting what is obj 
tionable in every system and from every source, render them- 
selves, as they may be truly styled, the most correct, energetic 
and successful practitioners in the world! How essential!} 
necessary, then, for the cause of humanity, that the details of 
American practice be faithfully recorded, as criteria wher< 
to test specious theories, not founded in practical observation ! 

There are now published in the United States several excel- 
lent periodicals, whose value and claims on public respect and 
patronage we most cheerfully acknowledge. So far from en- 
tertaining any sentiment of hostility or unkindness to those who 
have entered the field before us, we design and desire harmo- 
niously to co-operate with them in labouring toad ' \e the same 
great object, to advance tlie interests of that profession in which 
the good of society is most deeply and vitally involved. 

But although they have done and arc still accomplishing much 
for the improvement of medicine, and are justly entitled to the 
gratitude of physicians, and the appellation of benefactors of 
mankind — the profession at the South have long regarded and 
anticipated, as a most desirable object, the establishment of a 
Journal that should collect and preserve the valuable discoveries 
and improvements of Southern practitioners relative to the na- 
ture and treatment of dis-ases incident to Southern climates, 
which, for the want of some such convenient and suitable n 
sit. -lv. are generally entombed with him with whom they or 
gate, and thus forever lost to the world. 

It has long been lanv nted that in consequence of the obsta- 
cles that have hitherto existed, with very rare exceptions, the 
rich treasures of individual knowledge arising out of extensive 



•;>().] Introduction. 



experience, close application, accurate observation, and the most 
correct and rigid reasoning, have not been allowed to emanate 
from or survive their possessor, unless through tlve uncertain 
medium of oral communication. 

Unwilling that such evils should longer exist, or that South- 
ern physicians should longer want an appropriate vehicle of 
communicating to each other and to the world the valuable 
results of their observation, practice and reflection, we offer to 
our cotemporaries the pages of a monthly periodical, cordially 
inviting them to co-operate with us in the enterprise* and confi- 

/dently trusting that they, with equal :zeal and interest, will come 
to our assistance, and sustain a work so desirable, so important 
to science and to humanity 1 

As the principal design of this Journal is to collate and com- 
. municate practical information ; practical essays of all kinds, 
'1 histories of epidemics, reports of cases, the application of new 
remedies, and all interesting medical facts and experiments, 
will be thankfully received. Lung theoretical disquisitions, and 
'prolix discussions on controverted points, will be excluded from 
uur numbers ; place, however, will always be given to commu- 
nications on the collateral sciences, and to all treatises that have 
a useful bearing, or that may be calculated to promote the grand 
object in view — the improvement of medicine. 

The various branches of natural history at the South present 
fertile fields for cultivation. What wealthy treasures — what 
rich rewards are here promised to the zeal, industry and enter- 
prize of the mineralogist, the geologist, the botanist, and the 
zoologist! May we not hope from these fruitful sources to 
derive mueh matter for our Journal, valuable and interesting, 
not only to physicians but to the whole scientific w r orld ? 

We feel deeply impressed with a sense of the weighty respon- 
sibilities and arduous labours in which we are about to engage, 
especially when we contemplate the vast extent of science which 
must be kept under constant review, the unremitting demands on 
our time, the enlightened tribunal before which we must appear, 
and above all, our obligations to the sacred cause of humanity I 
Nor should we have ventured to assume such high responsibili- 
ties and to embark in such laborious duties, were it not for the 
great advantages and facilities afforded us by our connexion 
with the Medica] College of Georgia, the pledge of support made 



Inlrodwch [June, 



as by the rest of the Faculty, the assistance promised us by many 
other eminent physicians, and a confident reliance on the cordial 
co-operation of libera] and enlightened mi mbers of the profession 
every where throughout our country, especially in the Southern 

and Western States. 

The College Library, to which we have constant access, will 
receive a regular supply of the most valuable medical books as 
fast as they issue from the press, to reviews of which a portion 
of our Journal shall be devoted. 

Our sole object, as reviewers, will be to present to our read 
a faithful and plain analysis of new books, whereby to attr: 
attention to their merits, and assist in promulgating useful know- 
ledge. We will only exercise the invidious office of exposing 
errors and defects, where they militate against sound doctrine 
and safe practice, and are thereby calculated to mislead the 
younger and less experienced members of the profession. 
Attached to no party in medicine, advocates of no particular 
doctrine, eclectics in science, zealous for improvement but Oppo- 
sed to useless innovation, we trust we shall be able, unbiassed Im- 
partiality or prejudice, to discern and commend what is excellent, 
and condemn what is erroneous, without reference to the source 
whence it comes. 

Besides the valuable Journals of our own country, the mi 
approved periodicals of Great Britain, France, Germany and 
Italy, will furnish an inexhaustible fund of materials, that cannot 
fail to add utility as well as interest to our numbers. 

The monthly form has been selected, because best calculated 
to an.v/, er tli" purposes designed, being preferable to either quar- 
terly or hebdomadal publications. The former do no1 emanate 
from the press sufficiently often to maintain a constant and regu- 
lar supply of the newest intelligence in medicine, and the latter 
are necessarily restricted to a compass too narrow to admit ol 
any but v< ry short pieces, without dividing them into several 
parts, to be continued through successive numbers, which at 
once destroys much of the interest they might otherwise excite. 

Contributors are requested t:> make their communications ovei 
their own proper nam< s, as anonymous and fictitiously sign' i 
ad with little interest, if read at all. 



1836.] Remarks on Puerperal Peritonitis, 



Paet l— original matter. 



ARTICLE I. 



*uerperal Peritonitis. By J. P. Garvin, M. D. 
of Waynesborough, Ga. 

» Among the diseases to which the human system is liable, but 
re more dangerous in their character, or more- rapid in 
their course, than Puerperal Peritonitis. \From the first notice 
of ics appearance as an epidemic in 1664, to the present time, 
frequent investigations have been made of its nature, and of the 
treatment host adapted to its care ; but its true nature was long- 
involved in obscurity, and consequently the treatment Avas ge- 
nerally inefficient, and often pernicious. \ Modern research, how- 
ever, lias in a great measure dispelled tills obscurity, and at the 
present day, there exists but little difference of opinion as to its 
pathology. But in rclatidn^towito-.rcmcdial course proper to be 
pursued, practitioners do not evince the same unanimity. This 
fact renders it important, that observations tending to establish, 
or set aside the prevailing methods of treatment, should be laid 
before the profession ; and it is with a view to this, and not. with 
the expectation of offering any thing novel, either respecting its 
pathology or treatment, that the writer presents the results of 
his experience. m 

\ Puerperal fever has always been considered ^ disease of high* 
\y dangerous character, even in its sporadic form ; but it is when 
it becomes an epidemic, that it assumes its most formidable as- 
pect — then dismay heralds its approach, and death too often 
follows its footsteps. \ Some writers have asserted that in fatal- 
ity it ranks next to the Plague. | This estimate of its danger 
may have been correct in former times, under the treatment 
suggested by an erroneous pathology, but at the present day, it 
will scarcely be ranked so high in the scale of malignity. Still, 
though modern investigation, by developing its true nature, lias 
disarmed it of many of its terrors, yet there are few diseases 
which excite greater alarm in the breast of the patient, or bring 
n^ore anxiety, to the mind of the medical attendant. 

v The cases of Puerperal fever which have been observed by 
the writer, with a few exceptions, were of an epidemic charac- 
ler. XThe number of cases, the violence anil rapidity of their 
oursc, and the absence of all the usual causes, justify us, we 
think, in attributing to them an epidemic origin. No meteorolo- 
gical register was kept during its prevalence, neither was any 
marked peculiarity in the season observed. For some time pre- 
vious, anginosc affections had been common, and scarlatina pre- 



Remarks on Puerperal Peritonitis. [June. 



vailed to a considerable extent That the peculiar atmosphe- 
ric constitution by which some erruptive diseases are propaga- 
ted, has an agency in exciting puerperal fever, we are not pre- 
pared to assert, but the histories of this disorder generally, no- 
lice the ^contemporaneous prevalence of some of the exanthe- 
mata. Gordon states that 'leresypelas and puerperal fever be- 
gan at Aberdeen at the same time, and afterwards kept pace 
together — they both arrived at : their acme together, and they 
both ceased at the same time." i Clarke says, that during the 
prevalence of an epidemic puerperal lever, which he describes, 
" eruptive diseases, particularly those which are attended with 
great depression of strength, had attacked great numbers of pa- 
tients. Ulcerous sore throat with or without scarlatina had 
been very general." Armstrong asserts that it frequently pre- 
vails with eresypelas. The constitution of atmosphere which 
generates disease, is a subject of deep interest, but the light of 
science is yet too feeble to penetrate the darkness by which it is 
shrouded. Wet, if we may be permitted to judge of the pro- 
gress of future improvement by the past, we may indulge the 
hope that at some day, not far distant, this mystery may be un- 
veiled. \ 

Puerperal fever has been supposed by some eminent writers 
to be of a contagious nature ^ and it must be conceded, that 
there are many facts recorded in the histories of the disease, 
which strongly tend to confirm this opinion, lllowever, in this 
country at least, it is believed that there areHout few who con- 
sider it to be contagious, except under peculiar circumstances^ 
In the cases which came under the writer's notice, there was 
nothing which in the slightest degree indicated a contagious 
origin. ) 

^nis disorder generally makes its attack during the week suc- 
ling delivery ; but some cases have been related, which be- 
gan at a much later period, and a few which were supposed 
to have commenced before the confinement of the patient, llow- 
ever, the most common time of its access, is on the second or 
third day. I hi general, those attacks which are earliest made 
after delivery, are most violent and dangerous.— The most ma- 
lignant case which we have ever witnessed, began a few hours 
alter the birth of the child./ 

Puerperal fever is generally ushered in with chills or rigors. 
In some cases the patient is not conscious of any cold stage; 
yet it is probable that in no instance i^ it entirely absent, al- 
though so slight and transient, as to escape notice. The cold 
stage lasts but a short lime, and is followed by considerable heat, 
and dryness of the surface. Pain is fell in the hypogastric re- 
gion, in some cases very acute, in others dull and obscure, and 
if pressure be made at, or near the seat of the pain, a sensation 
of soreness is produced. This soreness soon spreads over the 



lS3o.] Remarks on Puzrperql Perllonilii 

whole or the greater portion of the abdomen, which soon bo- 
comes slightly swollen. The pulse at this stage generally ranges 
between 120 and 130 in a minute, and is usually full and strong, 
and communicates a thrilling, or " vibratory'' sensation to the 

finder ; vet in some of the worst cases, it is small and weak from 
the beginning. The stomach is often affected with slight nau- 
sea, and occasional vomiting — the bowels are constipated — the 
tongue covered with a whitish coat, and the thirst considerable. 
The breathing is hurried and a cough attends, which in some 
instances, is very frequent and distressing. The patient is gene- 
rally restless, but in her moments of quiet, lies upon her back, 
with her feet drawn up. ( The secretion of milk, if it has com- 
menced, is soon entirely Suspended, and the lochial discharge 
is soon materially lessened in quantity, or is suppressed] After 
this state of things has continued for some hours, varying in 
different cases, there is generally a considerable remission of 
all the symptoms, with the exception of the frequency of pulse, 
which is rarely much abated. / This remission often raises in 
the minds of the patient's friends sanguine hopes, which are soon 
to be disappointed; for the disease soon renews its destructive 
career, with a violence which seems to have gathered strength 
during the previous calm. Some time after this return of the 
violence of the disease, the pulse increases in frequency, and 
loses some of its volume and strength — the abdomen becomes 
more tumid, and the tenderness is sometimes so exquisite, as to 
render the slightest pressure insupportable. The countenance 
expresses considerable anxiety, and there is occasional delirium. 
\ The thirst is often insatiable — the tongue assumes a dark or 
brownish color, and, in some instances, a vomiting of a dark 
fluid, and frequent and similar discharges from the bowels occur. 
As the disease continues to progress, the pulse becomes more 
feeble, and so frequent, as to render it difficult or impossible to 
count it — the delirium is constant — the abdomen very much 
swollen, and the discharges from the bowels involuntary. In 
this condition, the patient lies for a few hours, and death then 
eloves the melancholy scene. 

The foregoing is a description of the disease as it appeared in 
the most malignant cases witnessed by the writer. There was 
not, however, an entire uniformity in the symptoms, in every in- 
stance. ' In some, but little nausea or vomiting occurred, and in 
one patient, neither of these symptoms was exhibited in any stage 
of the disease. The bowels were not uniformly constipated, and 
di arrhoe a sometimes shewed itself at an early period, and was 
Usually a favourable symptom. With some patients the delirium 
was slight and occasional ; with others it was perfect and con- 
tinued. We witnessed one case in which the patient could lie 
upon either side during the whole continuance of the disease. In 
one or two instances there was -soms dysuria. The abdominal* 



n I ' Peritonitis, [June, 



■ pressure, and greal £ 
>ms uniformly pn - 
( The duration of^uerperad fever varies in different I and 

in different seasons. In the sporadic cases, h 
c >urse in from five to nine days. I In the epidemic form 

and four or five days. Ir is stat 



stween one andfouror five days. Ir is stat 
h has taken place in less than twenty-four hours afti 
attack. AWehave seen no case fatal before the third, nOr at a later 
period than the fourth day. When the disease was subdued by 
the treatment adopted, the symptoms gave way early hut the 
patient rarely regained her usual health until after a consid rable 
lapse of time. 

No opportunity was afforded for post mortem examination, 
but so fully and frequently have these been made, by eminent .\\\A 
ipefent men, that there seems to be little left to be learned, in 
relation to the morbid appearances developed by dissection. \ 
Evidenced of peritoneal inflammation present themselves in every 
instance. Appearances of inflammation and its eon ces, 

are also manifested by various abdominal and pelvic viscera : but 
these seem to result from the spreading of the peritoneal inflam- 
mation to those organs; and, indeed, to this exi- risidn th< re seems 
generally to be an irresistible tendency. | This view of the nature 
of this disease will account for the want of uniformity in the symp- 
toms in different eases, and will explain the mode by which m 
of them arc produced. Thus,\the constipation probably r< si Its 
from the extension of the inflammation to the muscular c a* i f 
the intestines — the diarrhoea in the latter stages, from its fart! 
extension to the mucous coat, and thedysuria, from thebladd< r 
having become involved. iThese examples will suffice to show 
in what manner many of tne symptoms are originated. Other 
appearances, which do not admit cf such a solution, arc proba- 
Lhe resr.lt of sympathy of other parts with the organs which 
ii ive thus become successively involved. There so.mii< to us to 
l)e no good reason for a b lief that this inflammation is of a pecu- 
liar character. It. resembles inflammation of any other serous 
membrane, and its peculiar fatality depends upon the extern 
membrane attacked, and the Dumber and importance of the or- 
which it involves in its course. With tins view of the 
nature of puerperal fever, it cannot be a matter for surprise that 
its unobstructed course is <<> rapid and its termination so fatal. 

Armstrong divides the disease into two the 6rs1 o 

inflammatory, and the second, or stage of effusion or collap 
Dewees con id ra that there is another, intermediate to th se 
stages, which he denominates the "gangrenous," and which he 
defines as that -state of the parts which resembles death, bui i- 
not death." For practical purposes, this last division is un. • 

ary, as there are no known signs by which ii presence 
manifested l It is highly important thai we should be able. to 



& 



1830.] tictnarks on Puerperal Peritonitis. 9 

distinguish the inflammatory stage from that which succeeds it ; 
for it is only during the existence of the former that any mode of 
treatment offers the least prospect of success. J Yet it has been 
declared by high authority, that " the first stagps has no disco- 
vered character by which it can be distinguished from the se- 
cond." Armstrong has given a description of the first stage, 
and though it has been objected to it, that it depicts no appearan- 
ces which may not accompany the last, yet it is acknowledged 
to be the best which has yet been furnished. He says, "in the 
first stage, after tfie rigors have ceased, the pulse is hardly ever 
loss than 120, and sometimes (though as far as I have observed, 
very seldom.) as high as 140 in a minute; the blood does not 
seem to flow in a soft, easy, and natural current, but comes 
against the finger with a kind of vibratory motion, and more 
than ordinary pressure is commonly required to stop its course 
along the artery, which feels rather hard and tense. The skin 
is dry, and hotter than natural, the patient complains of great 
pain, and soreness of the abdomen, breathes forty times in a 
minute, vomits mucus and bile, is generally bound in the belly, 
has a white dry tongue, considerable thirst, and labors under the 
restlessness and irritation of fever." To this description we 
will venture to add, that during the continuance of the first 
stage, the pulse maintains about the same degree of frequency 
which characterized it when the disease was first fully developed. 
A very marked and permanent increase in its frequency, is 
usually the first appreciable sign that the boundaries of the first 
stage have been passed. 

There are but few diseases which require a more prompt and 
energetic application of remedies to ensure a successful issue, 
than puerperal peritonitis ; and yet it rarely happens, at least 
to country practitioners, that the patient is seen until some hours 
after the access of the fever. 1 The symptoms are too frequently 
attributed to some transient cause; and when at last the patient 
is undeceived, and the physician called, he too often finds that 
the golden moment for successful action has passed aw r ay, and 
he is compelled to stand by with folded arms and witness the 
swift ravages of the destroyer, j These remarks are particularly 
applicable to sporadic attacks, and the earlier cases of an epi- 
demic visitation. I It is a truth, to which in the present state of our 
knowledge there is no exception, that it is only in the first stage 
that the disease can be successfully combatted. . It is irue that 
occasional recoveries have taken place after effusion had occur- 
red, but such instances arc rare, and cannot fairly be held to be 
exceptions to the rule, inasmuch as they never result from our 
remedial applications, but arc consequent upon some occult con- 
si ituiional operation. Since more correct pathological views of 
the disease have prevailed, venesection has generally been con- 
sidered as an indispensable operation in the treatment. Indeed 



T0 Remarks on Puerperal Peritonitis. [June; 

the testimony in its favor is ample and conclusive. The follow- 
ing statement of deaths under different modes of treatment, we 
have extracted from Mcintosh, and it plainly indicates the supe- 
riority of bloodletting over all other curative methods, from which 
it is excluded. 

"The celebrated Dr. William Hunter saved one patient only 
out of thirty-two ; his practice became fixed to give a good wine- 
glass full of brandy at the commencement of the disease. 

Dr. Hulme, who considered the disease partly of a putrid 
naiure, and who employed bleeding in small quantities, and only 
as a secondary remedy, lost almost every patient. 

Dr. Leake, who recommended bleeding in small quantities, 
and at long inte.vals, and who gave his patients bark, beef tea. 
and cordials, to prevent putridity, lost thirteen patients, out of 
nineteen, in one season. 

Dr. Gordon, when he adopted a w T eak, vacillating practice, 
lust twenty-three out of twenty-seven cases ; but afterwards he 
used early and large bleedings, and out of fifty patients he lost, 
only five. 

Mr. Hey, of Leeds, saved only three out of thirteen cases be- 
fore he began to bleed ; but by this sad experience he was after- 
wards led to bleed boldly and early, and he lost only two out of 
thirty-six." 

To this testimony in favor of bloodletting, we might add that 
of Denman, Armstrong, and many other distinguished practi- 
tioners. That of the first mentioned writer is particularly strong 
and convincing ; the more so, as he came to his conclusions in 
its favor in defiance of all his prejudices and preconceived opi- 
nions. These facts not only prove bleeding to be a powerful 
and appropriate remedy, but they also shew, that to be ser- 
viceable, it must be early and freely employed. \ Among the 
advocates for venesection, some difference of opinion exists as 
to the extent to which it should be carried, and the frequency 
with which it should be repeated. Some writers have specified 
the precise quantity of blood, more than which they deem it 
unsafe to take ; but it is doubtless injudicious to fix upon any 
given quantity as a limit. \The only safe rule is to abstract a 
quantity sufficient to make a decided impression upon the sys^ 
tern, and to repeat it whenever the pulse recovers its volume and, 
strength, and the abdominal pain and soreness arc still unabated. ^ 
Dewces and others recommend that the first bleeding be carried 
to an extent sufficient to produce faintness ; and this is a good 
rule for our government in all cases accompanied by high arterial 
action, and to which we have been called early ; but in those 
Cases where from the beginning the pulse has been very small. 
frequent, and feeble, there is some doubt as to the propriety <»f 
so bold an application of the remedy. However, as this condi- 
tion of the pulse usually indicates the most intense and danger- 



183G.] Remarks on Puerperal Peritonitis. 11 

ous form of the disorder, it may be that the failure of blood- 
letting under such circumstances, is to be attributed rather to 
the intensity of the disease, than to any inapplicability of the 
remedy. But venesection, to be beneficial, must be confined to 
the first stage ; in the second it will serve but to hasten the fatal 
termination. Though an early resort to free bleeding, aided by 
other appropriate remedies, will speedily arrest the progress of 
the disease in a large majority of cases, yet so favorable an issue 
is not always to be expected, even when it has been practiced 
at the earliest hour and in the boldest manner. Peculiar malig- 
nity may characterize the epidemic ; or the circumstances by 
which the patient is surrounded may be such as to render any 
treatment ineffectual. The local depletion effected by leeching, 
often proves a valuable auxiliary to general bleeding ; but the 
<lilTiculty of procuring leeches in the country, and smaller towns, 
has hitherto confined the application to cases which occur in the 
cities. 

But though bloodletting be of primary importance, we should 
not rely upon it, to the exclusion of other remedies, i There is 
another remedial operation, which in efficacy is but little inferior 
to bleeding — we mean free purgation. We are aware that, in 
relation to the use of purgatives, there is some difference of opi- 
nion among practitioners ; but the objections urged against their 
use seem to be theoretical, rather than the result of observation. 
Indeed, nature seems to have indicated to us their applicability ; 
for the spontaneous diarrhoea which sometimes occurs in the 
early stage of the disease, is frequently followed by a marked 
improvement in the condition of the patient, and mucji injury is 
sustained when it is suddenly checked. \ If those who object to 
purgatives have arrived at their conclusions from an observation 
of their effects, when administered in such a manner as only to 
produce a gentle and occasional action on the bowels, it is not a 
matter for surprize that they found no benefit result from their 
use ; but an argument drawn from their effects when carried 
only to this extent, is entitled to no greater consideration th-m 
would be an argument against bleeding, founded on its want of 
success in the cases treated by Drs. Hulme and Leake. If we 
cxp ect to derive material benefit from the action of purgatives, 
we must administer them at such intervals, and in such doses, as 
will procure regular and free evacuation of the bowels. When 
this effect is produced, it will usually be followed by a subsidence 
of the abdominal pain, tension, and tenderness ; and by a gene- 
ral mitigation of the symptoms. \ \In illustration of the beneficial 
action of free purgation, we here subjoin a brief history of a case 
related by Denman. It occurred to him before he had begun to 
use the lancet, and whilst he was in the practice of relying much 
upon emetics. A soldier's wife was attacked with puerperal 
fever thirty-six hours after delivery. An antimonial emetic was 



12 Remarks on Puerperal Peritonitis, [Jni . 

administered, which vomited but twice, but produced seventeen 
stools in the course of six hours, fche hud some quiet sleep in 
the night, and sweated profusely. Saline draughts wen 1 then 
prescribed, and afterward a decoction of bark, and the patient 
perfectly recovered. I We will also relate briefly a case which 
came under our own observation, and in which the beneficial 
eflects of free purgation were also plainly exhibited. The case 
was of sporadic origin. Mrs. was attacked with puer- 
peral fever on the third day after delivery A We visited her six 
hours after the attack, and found her labouring under considera- 
ble pain in the hypogastric region, and great tenderness of the 
abdomen. The pulse was about 130 in a minute, the skin hot 
and dry, and there was much restlessness. Her condition, from 
previous disease, was such as seemed to render venesection of 
doubtful propriety ; it was therefore advised that she should 
take a scruple of calomel, which was to be followed in two hours 
by a mixture of senna infusion, and sulphate of magnesia, and 
this was to be repeated hourly until a free evacuation of the 
bowels w r as effected A On the next visit the patient was found 
to be much relieved, the pulse was reduced to 120 in a minute, 
and the abdominal pain and soreness materially lessened. The 
purgative had produced thirteen evacuations, some of them quite 
large* It was not designed to cause such powerful catharsis, but 
the patient had persisted in taking the mixture until it was ex- 
haust d, in consequence of the decided relief which followed 
each d scharge. The cathartic was ordered to be repeated, and 
its operation followed by an anodyne. On the next day we 
f nd the pulse reduced to 110 in a minute, and the pain and 
soreness had nearly disappeared. A moderate action on the 
\> wels, by the use of laxatives, was kept up for a few days, du- 
ring which time the patient continued to improve, and soon re- 
gained her usual health. But the use of purgatives should be 
co .lined to the first stage; after this has passed by, only the 
mildest laxatives should he administered, and when in the second 
stage, diarrhoea occurs, even these should be discontinued. 
There is some diversity of opinion as to what particular cathar- 
tics are best adapted to such cases. Armstrong advises large 
d B of calomel. In our hands, calomel has generally proved 
very sluggish and uncerta n in its operation ; and for these rea- 
sons, we have censed to rely upon it, except in combination 
with some more active article. As we believe that, purgatives 
are beneficial mainlv by the topical depletion which they effect, 
fr in the vicinity of the inflamed parts, we have generally pre- 
ferred those articles which produce the most prompt and copious 
discharges. 

Tl" !•«• are other auxiliary measures, whose application often 
proves beneficial. At the head of these, Armstrong, Blundell 
and others, place Opium. They advise that it should be given in 



I&36.] Remarks oft PUerperal Peritonitis. 13 

lar \ d >s i s. as its effects are of a less stimulating nature, than 
: used in smaller quantities. They suppose thai it possess- 
es s >me efficacy in lowering the irritability of the vascular system 
a j. I jhing inflammation. But there are many practitioners 

w ..> object t-. the use of Opium, not only in consequence of its 
stimulanl properties, but from a belief that it prevents, or retards, 
th ! > i mi of purgatives. This last objection we believe to 
be sr >undless; so far as our observation has extended, we have 
ir seen any such effect following the use of Opium ; and 
Armstrong asserts, that it does not interfere in the least w r ith the 
action of purgatives in this disease. In relation to its stimulant 
properties, the same writer declares, that they are manifested, 
only when small doses are administered. But Opium should 
never be given until after free depletion ; used then it will miti- 
gate the pain, and procure sleep, without increasing the inflam- 
matory symptoms in the slightest perceptible degree. Though 
Opium should not possess the power of extinguishing inflamma- 
tion, which has been ascribed to it, yet its action in mitigating the 
sufferings of the patient, renders it an article too valuable to be 
excluded from the treatment of puerperal fever. 

After bloodletting has been carried to as great an extent as 
may be deemed prudent, benefit will frequently be derived from 
the application of blisters. It has been advised to confine their 
use to the latter part of the first stage. They should be applied 
to the inside of the thighs, and not to the abdomen, for an irrita- 
tion of the abdominal surface would render those indications 
obscure which are to be derived from an examination of that 
part, by making it difficult to determine whether the sensation 
of soreness which pressure produces, is the effect of the blister, 
or of the continuance or increase of the internal inflammation. 

It has been recommended to mercurialize the system as 
speedily as possible ; and could this be effected at an early stage 
of the disease, it probably would prove serviceable. But puer- 
peral peritonitis is usually so rapid in its course, that we should 
very rarely be able to bring the system under the action of the 
mercury, except in a few of the milder cases, in which such a 
treatment would be unnecessary. Moreover, to produce ptya- 
lism by the internal use of mercurials, we should be compelled 
to administer it in such a manner as to prevent its rapid passage 
through the bowels, and thus, without any certainty of being able 
to procure its constitutional action, we should deprive ourselves 
of the opportunity of using purgatives, which certainly have 
much higher claims upon our confidence. However, in some 
instances, there is a degree of inflammation which remains even 
when the depletory process has been carried to its greatest possi- 
ble extent ; in these cases, calomel carried to the extent of slight: 
ptyalism, will be found highly beneficial. The best mode of ad- 
ministering it is in combination with opium, and aided by fric- 
tions of the abdominal surface with mercurial ointment. 



1A Remarks en Puerperal Peiutonitis. [June, 

? — — ■ — — — ■ — — ^ _ — 

Fomentations, with flannels wrung out of warm water, may 
he applied to the abdomen, as they often mitigate the pain; but 
as they are inconveiiient, and their beneficial effects but transient, 
it is probably besl to confine their use to cases attended by great 
severity of pain. 

Emetics, and oil of turpentine, have each their advocates ; but. 
our observation of their effects lias been too limited to warrant 
the expression of an opinion as to their merits. In relation to 
the oil of turpentine, the reports are very contradictory ; some 
lauding it highly, whilst others assert that they have never real- 
ized benefit from its use. 

The antiphlogistic regimen should be most rigidly enforced 
throughout the whole course of the first stage; and as the signs 
by which the commencement of the second is to be recognised 
are uncertain, it will be prudent to refrain from the administra- 
tion of anything of a stimulating nature, until the presence of this 
stage is distinctly ascertained. 

\ The treatment we have recommended is only applicable to 
the first stage — for the second there is no known remedy. In 
the language of a late writer, "the wretched patient must in a 
great measure be abandoned to her fate, as regards medical 
treatment. Stimulants — cordials — opiates may be administered, 
without reserve or apprehension, for the disease has spent upon 
her the full force of its pow r ers, and in this instance, w r e do not 
know what can injure or what can benefit the case." But how- 
ever hopeless the condition of the patient may seem, we should 
never desert her until life is extinct. Remarkable changes do 
sometimes occur, even under circumstances the most desperate, 
and we should always be ready, in events of this kind, to lend 
our aid. But even when no such alterations take place — when 
hope has expired in our own bosoms, our presence will often 
prove a source of consolation to the despairing friends of the 
sufferer, and will enable us to mitigate her pangs, and smooth 
her passage to the grave. 



v 






1S36.J Remarks oil the Treatment of RheumatisjtL 



ARTICLE IL. 

Remarks on the Pathology and treatment of Rheumatism, read' 
before the Medical Society of Augusta. By L. A. Dugas, 
M. D. Proiessdr of Anatomy and Physiology in the Medical 

College of Georgia, Member of the Geological Society of 
France, &c. 

Rheumatism is a disease of which we find no satisfactory 
account prior to the Sixteenth century, towards the close of 
which the attention of the Profession was called to it by the justly 
celebrated Ballonins, under the singular appeLation it still retains. 
Subsequently, the able pen of Sydenham delineated its charac- 
teristics in bold relief, and made it a prominent feature in No- 
sology. 

The term Rheumatism, according to Villeueuve, (Diet, des 
Sciences Med. torn. 48) is now applied to u a disease classed 
amongst the Phlegmasia?, located in the muscular and fibrous 
tissues of animal life, and attended with the following symptoms : 
pain, more or less intense, either continued or intermitting, fixed 
or wandering, and with or without heat, tumefaction, redness, 
and pyrexia. It usually terminates by resolution, sometimes 
suddenly, followed or not by metastasis, rarely by suppuration, 
and still more seldom by gangrene. Lastly its course is extreme- 
ly irregular, and its recurrence very frequent." 

Scudamore defines Rheumatism to be: ''Pain of a peculiar 
kind, usually attended with inflammatory action, affecting the 
white fibrous textures belonging to joints, such as tendons, apon- 
euroses, and ligaments , the synovial membranes of the bursa? 
and tendons ; and nerves; occasioned by tiie influence of varia- 
ble temperature, or by direct cold, or by moisture." It is called 
either acute or chronic, according to the intensity and combina- 
tion of the above symptoms. The causes of this disease are 
extremely obscure, although they have, by universal consent, 
been referred principally to atmospheric vicissitudes. Expo- 
sure to a cold and humid air is peculiarly favourable to its de- 
velopment Whether the low temperature and hygroscopick 
condition of the atmosphere, alone concur in such cases to give 
rise to Kheumatism, is extremely questionable. I believe it bv 
no means improbable that the electric state of this medium is 
highly influential in the production of Rheumatic pains, as well 
as of many other phenomena connected with nervous affections. 
It is not my design on the present occasion to inflict on the 
reader even a recapitulation of the numerous predisposing and 
proximate causes assigned to this disease. The profession i< 
happily becoming satiated with speculations on ©aases which 



i i Remarks on the Treatment of Rjieumatism. [June. 

must over escape our present means of investigation; and a e 
are now disposed to cultivate a more fruitful field — that oi 
fects. Lei us, therefore, hasten to the nature or Path* l< q < f 
Rheumatism. 

We have already said that it is now generally regarded . 
inflammation of the muscular and fibrous tissues. This is, in- 
deed, the doctrine which has prevailed, more or less, from the 
earliest notice of this disease. It is true that many have consi- 
dered this inflammation as of a peculiar kind. Sarcon ...id 
other believers in the agency of. animalcules, &c. in the c lusation 
of disease, exj lained this peculiarity by referring it to the ac q 
of those diminutive beings on the white humors of joints, 
Quarin viewed it as a constriction of the vessels, from cold. 
Boerhaave called it an inflammation not sufficient U »jp- 

puration. Cullen admits the inflammation, but adds that the 
muscular fibres are in a state of rigidity, which impedes and 
renders painful any movement. "It is," according to this 
tinguished pathologist, "an affection of these fibres Ives 

an opportunity to the propagation of pains from one j< int to ano- 
ther, along the course of the muscles; and which pains are 
more severely felt in the extremities of the muscles t< rminating 
in joints, because, beyond these, the oscillations are not propa- 
gated." (Cullen's 1st lines.) 

Bichat and Scudamore insist that it is a peculiar inflammation, 
but do not attempt to define its nature. ViUeueuve states that 
" several authors, without determining whether the proximate 
cause of Rheumatism be spasm, irritation, or debility, affirmed 
in general terms, some that Rheumatism was a peculiar affection 
of the nerves, others that it was a lesion of sensibility, and a third 
class that it was a special modification of the vital powers." (loc. 
»-it. P. 402). Villeueuve admits that the nerves of animal life 
may he the seat and even the primary scat of Rheumatism, but 
does not think those of organic life ever invaded by it. Scuda- 
more, in his definition of Rheumatism, enumerates very specially 
the nerves among the tissues affected by this peculiar inflamma- 
tion. Sciatica is accordingly considered by him a Rheumatic 
affection of the nervous trunk itself; whether of the nervous mat- 
ter or of the neurilemma, he docs not determine. 

It is evident that all the writers above cited looked upon 
Rheumatism as located alone at the scat of pain. Of late yens, 
however, attention has been called to a peculiar condition of the 
spinal marrow ;is invariably connected with lesions of sensibility, 
as well as with many of those affections classed among the 

Neurosc -. 
It appears that as far back as 1821, Mr. Player, in a letterto 

the Editor of the Quarterly Journal of Science, stated that " the 
occurrence of pain in distant parts (from tin* spine) forcibly at- 
tracted my attention, and induced frequent examination of the 



1-S38.J Remarks on the Treatment of Rheumatism. .. 17 

spinal column ; and after some years' attention, I considered my- 
self enabled to state, that in a great number of diseases, morbid 
symptoms may be discovered about the origins of the nerves 
which proceed to the affected parts, or to those spinal branches 
which unite them ; and that if the spine be examined, more or 
less pain will commonly be felt by the patient on the application 
of pressure about or between those vertebrae from which such 
nerves emerge." 

In May, 1828, Dr. Thomas Brown published in the Glasgow 
Medical Journal a very interesting article *' on Irritation of the 
spinal nerves," the substance of which he asserts he read before 
the Medical Society of that city in 1823. In this paper he refers 
the morbid phenomena of the spinal nerves to a state of increased 
irritability of their origin, which he terms "spinal irritation." 
This affection of the spinal marrow is attended with more or less 
pain on pressure of the vertebra? at the diseased point. Some 
<>{' his cases were evidently Rheumatic, and indeed had been 
treated as such by the previous attendant. His treatment con- 
sisted principally of applications to the spine. 

Dr. Darwall, early in 1829, inserted in the Midland Medical 
and Surgical Reporter, his " Observations on some forms of Spi- 
nal and Cerebral Irritation." He would establish the principle 
- that disorders attacking the origins of nerves, or their attach- 
ment to the central mass, whether this be the brain or spinal 
chord, always disturb the functions of the organs to which such 
nerves are destined." 

" A treatise on Neuralgic diseases, dependent upon irritation 
of the spinal marrow and Ganglia of the sympathetic nerve," by 
Thomas Pridgin Teale, was issued from the London press in 
1829. This invaluable publication l\as opened to our researches 
one of the most fertile fields ever explored by the profession ; one 
from which have already been elicited some of the most impor- 
tant truths in the domain of Pathology. The observations of 
Teale not only confirm the views of those who wrote before him 
on Spinal Irritation, but are also extended to lesions of the 
sympathetic ganglia. I would, however, at present, refer only 
to that portion of his work which relates to our subject. It con- 
tains a number of cases illustrative of his doctrines, some of 
which, like those reported by Brown, had been considered as 
rheumatic by other physicians, and indeed presented symptoms 
*uch as are usually said to characterize some forms of this dis- 
ease. It is not a little remarkable that with such facts before 
them, neither Brown nor Teale should have thought of treating 
the more acute forms of Rheumatism in the same manner. They 
make no reference to it, and the merit of introducing a new and 
rational mode of treatment of Rheumatism, was reserved for 
our countryman, Dr. J. K. Mitchell, of Philadelphia, who, in 
May 1831, published in the American Journal of Medical Sci- 
3 



lb Remarks on the Treatment of Rheumatism. [June, 

ences, his first article on the subject: In addition to the eight 
cases then reported, Dr. M. inserted five and thirty more in the 
game Journal. August 1833; all of which concur in confirming 
the spinal origin of Rheumatism, whether acute or chronic. 

I must confess that neither of the transatlantic publications to 
which I have referred, had led me to reflect on the nature of 
Rheumatism ; nor was my attention drawn to it until the ap- 
pearance of Dr. Mitchell's first paper. On reading this, how- 
ever, and comparing his doctrine with the prevailing theories of 
the Pathology of this malady. I became at once convinced that 
it was impossible to reconcile ihe various symptoms of this dis- 
ease, on any other principle than that of spinal irritation, and 
that with this view of the subject, the treatment would be per- 
fectly simple and efficacious. 

From the definitions usually given of Rheumatism, the pain 
is manifestly considered as dependent on the inflammation of 
the parts in which it is seated. That simple inflammation of 
the muscular or fibrous tissues should be the sole cause of the 
pain. I cannot admit. It is true that the patient's sufferings are 
generally proportioned to the degree of apparent inflammation,, 
and consequently that acute is more distressing than chronic 
Rheumatism. But, I would ask, why are not other inflamma- 
torv affections of the same tissues equally painful ? It is impos- 
sible not to perceive, on a close examination of the phenomena, 
of Rheumatic inflammation, that they present several peculiari- 
ties, which evidently distinguish it from ordinary inflammations ; 
and indeed they are so strong as to have led some eminent pa- 
thologists to deny that they constituted a whole, entitled to the 
denomination of inflammation. Inflammat on is usually said to 
be characterized by redness, heat, tumefaction, and pain, all of 
which we find united in the most violent f<rms of Rheumatism. 
But there are sequela; or terminations enumerated as belonging 
to inflammation, which never follow Rheumatism. Inflammation 
lerminates by resolution, suppuration, or mortification. Its rise, 
progress, and termination, are more or less gradual; subject to 
certain laws, and it is in most cases susceptible of removal by 
the antiphlogistics. Rheumatism obeys no such laws of develop- 
ment, progress, and declension; but, not unfrequently, manifests 
itsclfand disappears with a degree of suddenness utterly at vari- 
ance with the course of ordinary inflammations. Its mode of 
termination is invariably the same, (by resolution) never pro- 
ceeding to suppuration, or to mortification; and finally, it rarely, 
if ever, yields to the antiphlogistic treatment directed to the scat 
of pain.* 

* I am ;iw;iro that there an- cases on record, of suppuration and even of 
mortification having occurred in parts affected with Rheumatism, hut they 
are so few that we may be permitted to doubt their authenticity, or rather to 
ook upon them as mere coincidences, dependent on complications or pecu- 



1836.] Remarks on the Treatment of Rheumatism. 19 

The theory of spinal irritation is that alone by which all 
these peculiarities can be explained. If the point from which a 
given nerve arises be diseased, the functions of this nerve must 
necessarily be vitiated ; and if its functions be vitiated, the con- 
dition of those parts to which said nerve is distributed must also 
be morbid. In the case of Rheumatism, the morbid condition 
of the parts deriving nerves from a diseased portion of the spi- 
nal chord, consists of inflammation of a peculiar character, in- 
creased sensibility of the nervous extremities, amounting usually 
to pain more or less acute, and, in many instances, diminished 
motility. All admit lesions of motility to depend on an affection 
of the motor system of nerves, and, inasmuch as the motor can- 
not be separated or distinguished from the sensitive fibres after 
their union in a common nerve, such lesions are referred to the 
spinal chord. Why then should we not also regard all lesions 
of sensibility not the result of local injury.f attributable to a 
morbid state of that chord which presides over this function ? 

Again, we see that not only the onset of Rheumatic inflam- 
mation, but also its termination or cessation, is in many instances 
extremely sudden, and indeed that sudden metastasis is by no 
means unfrequent. These circumstances are most satisfactorily 
accounted for by the fact that nerves arising very near each 
other may be distributed to parts very remote. For instance, 
the nerves of the right hand, though very distant at their termi- 
nation from those of the left, are nevertheless very near them at 
their origin in the medulla spinalis ; and hence a slight affection 
of the medulla might for a time exist in one column, and subse- 
quently extend or remove to that adjoining it ; thus producing 
at first a derangement of function on one side of the body, and 
then on the other. My opportunities have not as yet been suf- 
ficient to enable me to assert, from observation, that metastases 
of Rheumatism are limited to the periphery of nerves arising in 
the proximity of each other. This, however, I am strongly in- 
clined to think, will most frequently be found to be the case. 
Whenever an upper and a lower extremity are simultaneously 
affected, they most frequently belong to the same side of the 
body. It will probably also be observed that the justly dreaded 
translation of Rheumatism to the heart, is a much more com- 
mon sequel of an affection of the upper than of the inferior ex- 
tremities. 

The difficulty attending post mortem examinations of the 
medulla spinalis, has very much retarded our knowledge of the 
pathological anatomy of this organ. Its condition in fatal cases 

liarities of habit. The success of the antiphlogistic treatment directed to 
the seat of pain, is equally doubtful, esppcially when we bear in mind the 
strong tendency of Rheumatism to translation or sudden cessation without 
appreciable cause. 

Gout, Rheumatism, and Neuralsria. 



30 Remarls mi the Treatment of Rheumatism. [Jul* , 

of Rheumatism hns never been systematically investigated. 
We find, however, on record, a few cases which I think calcu- 
lated to throw much light on our subject. One of these is re- 
ported in Johnson's Medieo-Chirurgical Review, (Oct. 1827. 
JP. 464) under the title of 4t Inflammation of the Spinal Marrow." 
A youth, some time after bathing in the Seine, experienced wan- 
dering pains, which subsequently extended to the whole surface 
of the body, and became so intense that the least touch would 
occasion loud cries. The pains continued unabated, delirium and 
diarrhoea ensued, and he died on the ninth day. On opening the 
spine, the medulla was, from the 7th cervical to the 8th dorsal 
vertebrae, evidently softened and infiltrated with pus. In the 
same Periodical (Jan. 1828, P. 184) is contained another case, 
in which the patient had suffered severely from Rheumatic 
pains in the upp* r part of the back, shoulders, and arms, and 
finally became paralyzed in his arms. Dissection evinced that 
from the 5th cervical to the 1 1th dorsal vertebra, the membranes 
of the spinal canal were intensely inflamed, thickened, and cover- 
ed with a bloody effusion. The marrow itself, for the same- 
space, was similarly inflamed and softened. 

Dr. Mitchell gives the history of two cases of spinal disease, 
as corroborative of his views of Rheumatism. The first* was 
one of caries of the lumbar vertebrar;, in which one ankle, and 
the knee of the opposite side were tumefied, red, hot, and pain- 
ful, afforded a fair specimen of acute Rheumatism. Relief 
promptly followed leeching and a blister to the affected spine, 
aJ though the ordinary treatment for Rheumatism had been pre- 
viously resorted to without effect. The second case was that 
of a physician who, after receiving an injury of the cervical ver- 
t.jbra3, experienced an attack of acute Rheumatism of the hands 
and wrists, which " w r as always relieved by remedies applied to 
the affected part of the spine, and aggravated by pressure or 
rough friction there." 

These four cases conclusively establish the fact, that irrita- 
tion of the spinal contents is attended with the train of symp- 
toms known to characterise Rheumatism. May we not then 
by legitimate deduction infer that there is a spinal disease when- 
ever wo encounter this train of symptoms ? If further evidence 
be requisite, it is abundantly furnished by the numerous instanc- 
es in which genuine, uncomplicated Rheumatism has been spee- 
dily cured by medication applied exclusively to the spine. Dr. 
Mitchell, reports forty-one cases successfully treated on the new 
principles. In my own practice I have used no oilier plan for 
the last five years, and its success has been uniformly prompt 
and decisive. An unwillingness to swell this communication, 

* American .Tourn;i I ofthi Medical Sciences, May, 1831, p. 55. 
\ American Journal of the Medical Science. August, 1838, p. 860, 



183G.] Remarks on the Treatment of '"Rheu *ji 

deters me from transcribing from my n >to book, s 
most interesting cases which came mirier my care-. 

Pressure over the vertebrae corresponding to the origin i 
nerves supplying the scat of suffering, though in many ins 
attended with more or less pain, is not uniformly So. In soine, 
not the slightest uneasiness is produced by it. I oannot howe- 
ver, coincide with Dr. Mitchell, in considering die tenderness, 
merely a proof of an irritated condition of the - spinal brac< s ;" 
for, whenever this tenderness dues exist, it almost invariably 
corresponds to the origin of the affected nerves. The degree of 
sensitiveness may perhaps be indicative of the condition of the 
membranes alone of the medulla. 

In the case before us, we have a happy illustration of the im- 
portance of localizing, and properly localizing diseases ; for so 
long as Rheumatism was thought to be an affection of the wrlole 
system, manifesting itself indifferently in one joint or another, all 
remedial agents were directed to the general system. How 
many poor wretches have we not seen subjected to the cruel 
inflictions of a regular mercurial salivation, a systematic course 
of sudorincs, antimonials, guaiacum, sarsaparilla, &c. the or- 
deals of steaming, vapourizing, sweating, &c. and after all, the 
patient doomed to limp the remainder of his days ! But I say 
that it must be properly localized : for those who view the dis- 
ease as confined to the seat of pain, will torture their patients 
with frictions, fomentations, vesications, &e. with as little success 
as those who endeavoured to drive out or neutralize the consti- 
tutional impurity. We have now, I trust, traced Rheumatism 
to its true source, and every remedy based on this belief, gives 
additional evidence of its correctness. Regarding the disease 
as seated in the spinal marrow, and believing its nature to be 
irritation or sab-inflammation, the treatment to be instituted is 
perfectly obvious. The local abstraction of blood, by leeching 
or cupping the surface over the affected medulla, followed by 
the more permanent revulsive action of vesicatories, constitutes 
the most efficient treatment of Rheumatism. In many slight 
cases, the mere application of a sinapism will readily allay the 
pain ; in others a blister will be required and may be, or not, 
preceded by cupping, according to the tenderness of the spine. 
the constitution of the individual, dec. When the local affection 
is so intense as to induce high febrile excitement, it may be pru- 
dent to take blood from the arm, though this should not be car- 
ried to excesss. The opiates will occasionally be found useful 
adjuvants. In obstinate chronic cases, the counter-irritation will 
be most advantageously kept up by the ointment of tartarized 
antimony, and should be persevered in, as long as the disease 
manifests a tendency to return. With this plan of treatment, 
I repeat, the disease will be found almost uniformly to yield in a 
few days, and without any internal remedies, or applications 



• >-) 



Analysis of the Hydrant Water of Augusta. [June, 



the sent of pain. Indeed, so confident do I feel of its efficacy, 
that I now look upon Rheumatism, not long since the apprpbri- 
um medicorum, as <5ne of the most manageable affections we are 
I on to treat. 



ARTICLE III. 

Analysis of the Hydrant Water of Augusta, passing through 
leaden pipes. By Lewis I). Ford, M. D., Professor of Che- 
mistry in the Medical College of Georgia. 

The extremely poisonous nature of the salts of lead has gen- 
erally and very properly created a doubt in intelligent commu- 
nities, as to the safety of using water that has been transmitted 
through leaden tubes. This feeling in this community, together 
with the occurrence of some cases of disease, which seemed to 
warrant the suspicion of injury resulting from the use of water 
conducted in leaden pipes, have led me to the particular exami- 
nation of this subject. I place the result at your disposal, be- 
cause I have not met with any detailed account of the method 
of proceeding in such an examination, and therefore, it may 
possess a general interest ; and because a knowledge of the fact 
us to the nature and degree of the impregnation of the water, 
with a saturnine preparation, may be of service to the commu- 
nity, cither in quieting their apprehensions as to its use, or in 
leading them to abandon it, according to their respective estima- 
tions as to the quantity of this preparation which may be used 
with safety. 

This water is brought in a wooden conduit from the spring, 
through the centre of the city. The service pipes inserted into 
the main conduit, are, iu the majority of instances, of wood, while 
others are of lead. There has never been discovered the slight- 
est trace of lend impregnation in the water that passes through 
the wooden pipes, although carefully examined in very many si- 
tuations: — while it is uniformly discoverable in every situation 
when it passes through the leaden ones. This difference is not 
surprising when we consider for ;i moment the construction oi 
the aqueduct, and the constant flow of the water from the ser- 
vice pipe . 

1. The qualitative analysis. — None of the usual agents of 
lead produce any precipitate with this water, except the foe* 



183*5.] Analysis of tlte Hydrant Water of Augusta. m:\ 

sulphuretted hydrogen gas, or its solution in water. Even the 
hydro-sulphates produce no discoloration. 

The sulphuretted hydrogen gas injures slightly the transpa- 
rency of the water, producing a brow color throughout it. — 
The water thus discolored deposits no precipitate after many 
days rest. 

After passing the water through good filtering paper, it is not 
discolored in the slightest degree by the sulphuretted hydrogen. 
This fact assures us entirely, that the preparation of lead is insolu- 
ble — but in a state of so minute division as to be suspended in the 
w iter without altering its transparency. It also explains the 
r i son why neither the sulphuric acid, the sulphate, the hydrio- 
date, nor chromate of potash will form a precipitate. 

To determine more satisfactorily the presence of lead, a gal- 
lon of the water was filtered — the filter dried perfectly, burned 
and the rcsidium placed on a glass capsule and a few drops of 
nitric acid added, boiled upon a sand both, and the heat continued 
until the mass was dry. A few drams of water were added and 
boiled for a moment, and the solution filtered. I need scarcely 
remark, that the object of treating the incinerated filter with ni- 
tric acid, is to obtain the lead in the state of one of its soluble 
salts, the nitrate. This solution with the sulphate of potash 
gave a white precipitate, — with sulphuric acid, and with the 
carbonate of Potash, a white precipitate, — with the chromate 
of potash it gave a heavy dense yellow precipitate. 

With a solution of hydriodate of potash, this solution produ- 
ces a yellow^ precipitate, and if the solution of the hydriodate be 
added with as little agitation of the test tube as possible, the 
precipitate is recognized by a practiced e} r eas the hyhriodate of 
lead, by the peculiar appearance of the contents, when they 
are thrown into motion, by turning the test tube in a circular 
direction ; the surface of the fluid in contact with the glass, ex- 
hibiting different shades of the yellow color, like the watered 
ribbon ; an appearance produced doubtless by the partial crys- 
tallization .of the precipitate. But this precipitate is recognized 
as the hydriodate of lead by a still more striking characteristic. 
By boiling the contents, a transparent solution is obtained, which, 
on cooling slowly and at rest, deposites on the sides and bottom 
of the tube beautiful, small, splendent yellow crystals. 

A polished plate of zinc immersed in a portion of the above 
solution, is speedily covered with a light spongy mass of pure 
lead. 

Thus each one of the foregoing: re-agents producing a change 
in this solution, characteristic of the presence of lead, their con- 
curring testimony establishes the fact beyond the possibility of 
doubt, that the water thus passing through these leaden pines is 
impregnated with one of the preparations of lead. What is this 
preparation? 



24 Puerperal Convulsions. [Juno 

If a portion of the water he evaporated to dryness, and sul- 
phuric acid be added to the residuum, an evident efiervesc 
is produced. Whence we infer thai if is impregnated \\ Lb 
carbonate of lead. Again, if a piece oi' lead be immersed in a 
jar of this water, with its surface exposed to the atmosphere, the 
bad is covered over with minute crystals oi carbonate of lead, 
in the course of a few days. 

2. The (j unit ('dative analysis. — To determine the absolute 
quantity of carbonate of lead in a given quantity of the water, 
233 ounces were filtered, the filters burned, and treated w ith 
nitric acid as above, and three ounces of solution of nitrate of 
lead obtained. A solution of chromate of potash being added in 
excess, the precipitated chromate of lead was suffered to 
side and washed three times, dried in the tube — from wh< nee it 
was removed and weighed. Weight exactly one decigram — 
equal to 1.544 grains Troy. Thus from 256 ounces, or two 
gallons, we obtain 1.696 grains of chromate of lead, which, ac* 
cording to Wollaston's scale, is equivalent to 1JJ8 grains of car- 
bonate of lead. Thus we arrive at the conclusion that th< re is 
1.38 grains of carbonate of lead in every two gallons of this 
water, which contains so much of the oxide of lead as, if unite d 
with acetic acid, would form 1.044 grains of sugar of lead — 
nearly one grain to the gallon. It is proper I should state that 
the water which has given this result was drawn from one of the 
longest leaden service pipes. I may at some future period en- 
deavour to estimate the reason w r hy this water acts upon the 
lead, when it is known that in innumerable instances water is 
transmitted through leaden tubes without being impregnated 
with it. 



ARTICLE IV. 

Puerperal Convulsions. 

hi the summer of 1633 1 delivered a lady of her second child. 
The d< livery was accomplished within an hour and a half from 
the first anouncemenl of labour. Beinghurried away to another 
rase. I left her very comfortable, 30 or 40 minutes after deliver) . 
About one hour and a half after, she was suddenly seized with a 
\ery violent convulsion, of that species described by Velpeau as 
Apoplectic Eclampsia. Before she could he administered to, 
• mother convulsion returned on the profound stupor and heavy 



I J Puerperal ( 25 

torous breathing which followed the first. A consultation of 
physicians was present The pulse being slow, hut full and 
il depletion was practise^ All the intermediate 
a;> ; ptoms pontinued notwithstanding. Soon after 

>nd paroxysm, I arrived. Whilst receiving the above 
account, a third paroxysui supervened, which I witnessed, and 
wfhich was very severe indeed — commencing during the stupor 
and stertorous bri athing, full pulse, foe, by a drawing of the eyes 
then the head to .mil the body was universally con- 

;ed, with frothing at the mouth, livid skin,/&cj This soon 
;ided, and was followed by the same apoplectic symptoms. 
On examination, notwithstanding the copious depletion from the 
arm, it was discovered that the uterine hemorrhage was very 
copious indeed ; the whole nankin, which had been but 10 or 15 
minutes in application, being completely saturated, beside a large 
quantity of coagulated blood surrounding her in bed. On the 
external touch, the uterus presented no firmness ; but the whole 
hypogastrium perfectly flaccid. The uterus was immediate ly 
sped and agitated repeatedly through the abdominal parietes, 
until its contractions could be distinctly perceived to return with 
increasing strength, every four or five minutes. From the first 
■ heat .on of the hand, no other paroxysm returned, and after 
Kit fifteen minutes from the. commencement of this operation, 
the apoplectic symptoms disappeared, and she opened her eyes 
with intelligent expression, looked about as if surprised at see- 
the family and physicians about her, and asked where was 
her child. It was brought, and she received it into her arms. 
She then asked for something to drink. A cup of weak tea was 
soon brought, which she drank sitting, spoke several times, 
was again placed in bed. 
I remained with her about an hour after, continuing the manual 
operation for exciting the uterus. Finding that she continued 
free from all alarming symptoms, I instructed her nurse to main- 
tain the perpetual contraction of the uterus by the same process 
i had used, and left her, complaining of nothing but some painful 
i ati ms in the uterus at every contraction, amounting to slight 
after pains. The haemorrhage had been reduced to the ordinary 
quantity for the period. 

A few months after, I was j ires* at with another lady, who, af- 
haying had several convulsions' of the same- character, the 
first occurring in the latter part of the second stage of labour, was 
then suffering the intermediate apoplectic symptoms. On direct- 
ive; attention to tha abdom n, the uterus was found in the same 
relaxed condition as in the form< r case. It was stimulated to 
action by the same means, and within from 20 to 25 minutes, the 
as well as the expression and color of the face, became 
na1 a) al ; she opened her i yes with a natural expression, yawned, 
I to uing her head to an * asy positio . It was found 

1 



2i> ml Convulsions. [Junc« 

that she also had flooded very copiously. She had no more con- 
vulsions. 

In view of the present state of the profession on this very in- 
teresting and important disease, T cannot withhold the focts of 

these cases from the public. They are given in the hope thai 
in the present imperfect state of the pathology and treatment of* 
these convulsions, the curative indications, in some cases ai 
least, may be made so plain as- to lead to more favourable prac- 
tical results. What is the pathology of these eases? Was- 
there a passive haemorrhage From the uterus? And was there 
at the same time a strong general action of the heart, and a> 
great determination of blood to the brain ? And did the exci- 
ting means used with the uterus equalize the action of the wholi 
system, by arousing the energies of this passive organ ; and thus 
by a prompt and decided derivation of excitement, at once re- 
lieve the brain of its ruinous burthen? Or was the Eclampsia 
a mere nervous phenomenon, arising out of the debility and con- 
sequent increased irritability of the motor apparatus ; and the 
symptoms strictly apoplectic, only a secondary effect, arising 
from cerebral compression from blood forced into the brain 1>\ 
the violence of muscular contractions in this spasm ? And did 
the excitement of the uterus so far employ the excitability of the 
system as to relieve other parts of that excess which predispo- 
sed to spasm ? Would not Ergot have produced the same be- 
neficial effects as the manual operation employed, if it could 
have been administered ? (yet it could not have been in either 
case.) May or may not the previous bleeding have prepared 
the system' more perfectly for this counter-excitation ? And 
would further bleeding have ever produced this equalization of 
action? Would not the patients have died without proper exci- 
tation of the uterus having been directly effected? May not the 
powerful antispasmodics which arc, when they can be, almost 
always exhibited in these cases operate, when they do operate 
beneficially, simply on this principle, (i. e.) exciting the uterus 
particularly, rather than the system generally I Would not tar- 
tar emetic have failed as well as continued depletion in these 
cases ? 

It is earnestly hoped, for ihc good of humanity, and the credit 
of the profession, that these facts and interrogatories may ieadtd 
more accuracy in pathology, and consequently, successful the- 
rapeutics. 

31. ANTONY. 



S:jt>.j Sketch of a case of Bfoficnoceh. ££ 



ARTICLE V. 

■ ch of a case of Bronchocele, successfully treated hy Iodine. 
By Wm. W. Lee, M; D. of fcdiantown, S. C. 

Brohchocele is a disease of such rare occurrence in the Uni- 
ted States, that many physicians pass through life without even 
an opportunity of beholding it. Its origin is exceedingly obscure; 
the supposition that it arises from the use of snow-water, to 
which it is ascribed in the Alpine regions, is disproved by the 
fact, that it prevails to a great extent in Java and Sumatra, 
where snow is unknown. It is also singular that writers rarely 
mention the duration of cases when cured. 

The case about to be related is interesting, both as it displays 
the therapeutical efficacy of Iodine, and from the short time in 
winch the cure was effected. 

May 21st. 1833, I was requested to visit Mrs. R. D. set 32 
years, labouring under goitre. The history of, the case w T as as 
follows: — Her mother had a small tumour resembling the 

num adami in males, but which continued indolent through 
life ; the daughter, about thirteen years previous to my visiting 
her, perceived a small tumour forming in the situation of the 
I gland, supposed to be a wen: she soon after married, 
from which time the tumour, which had previously exhibited 
little change, now began to enlarge rapidly, particularly after 
Vie birth of each child; indeed this seems to be almost a diag- 
nostic of bronchocele : — an eminent surgeon was consulted, who 
proposed extirpation, to which she would not consent. At the 
time of my visit, it had so increased as to project anteriorly as 
far as the point of the chin, extending laterally to the angles of 
the jaws, and occupying the whole space between the chin and 
clavicle; its surface was smooth, uniform, and hard; her head 
was tixed ; elevation, depression, and rotation, w T ere alike impos- 
sible ; the dyspucea forced her to sleep resting on one side in a 
li-recumbent posture, and when labouring under catarrh, 
threatened suffocation. Recollecting the extreme danger, and, 
in one instance, fatal result attending two cases related by 
( r;>»ch, I expressed the opinion that the extirpation of a tumour 
of such magnitude, and so vascular, would cause death by ha> 
morrhage ; at the same time, I stated that although the proba- 
bility of a cure was greatly diminished by the long duration of 
the disease, I thought there* was a possibility of it by a newly 
discovered medicine (Iodine) ; and at the earnest solicitation of 
herself and husband, consented to make the effort. 

Considering Magendie's tincture needlessly strong, I preferred 
Cartwright's formula. (Med. Rcc. No. 44, p. 260.)' 



£8 Sk '''. 

B Iodine, xxvj. 

Alcohol, 5j. IP. 55 drops thrice a day ; also to 
apply by friction, morning and fcvening, the I imenl :— 

9 Tinct. Iodinte, (Gartwright) 3j. 
Liniment. VolaT. 5vij. u>. 

I considered the prospect of a cure sodoulJtftil, thai T neg 
ed (what I have since greatly regretted.) to take the dimensions i 
the tumour; still I recommended a svad\ perseverance in the 
use of the remedy. 

June 25th. 1 uas truly astonished at the wonderful change 
effected ; the tumour had been reduced to the size of a g< >< »se i 
over the trachea, and had lost its redness; respiration was per- 
fectly free, for she could sleep in any' position : the power of ele- 
vation, depression and rotation was restored, and she seemed 
full of hope. 

July 9th. I was equally gratified at the rapid improvement ; 
without a manual examination, even the existence of disei 
would not have been suspected ; the power of motion was com- 
pletely restored ; she could sleep even in the horizontal position, 
and expressed herself both surprized and delighted at tne felici- 
tous results; — indeed it was to me a source of equal thankful- 
ness and gratification that I had been instrumental in restoring 
to health and usefulness a wife and mother of a large family, 
dependent for subsistence on the personal industry of herself and 
husband. I made -a minute examination of this case at a sub- 
sequent period, (Nov. 1834) and found it precisely as last des- 
cribed; there was one circumstance which had caused me much 
solicitude, its possible increase after parturition; she had during 
this interval given birth to another infant ; but my gratification 
was extreme to perceive no disposition to a recurrence 'of disease; 
I was therefore led to consider her radically cured. 



1836.] Diagn st. Vfa 



PaAt II.— REVIEWS A#D 

On the Diagnosis of Diseatei of tl 
f anion of their phi/sic/' ark I general signs. B; 
Gerhard, M. J)., Physician to the mdckley Hospital; 
furer in the Philadelphia Medical Ass'ociatipn 1 ; Fell 
Philadelphia College of Physicians; McmtaJ of the Society 
Modicale d'Observation, and of the Societe Anatomiqi 
Paris, &c. 8vo. pp. 1S;J, Philadelphia, Key & BiddleylS36. 

It is truly with pleasure, we call the attention of the Prbics 
sion to the work before us. The diseases of which it treats. 
certainly constitute one' of the most common and most lata I 
classes of affections we have to encounter. ' That a correct di- 
agnosis is the first and most important step in the treatment of 
■ase, will not be denied; yet, without the possession of the 
physical means instituted by Avenbrugger and the immortal 
Laennec, it is absolutely impossible to attain this desiral 
knowledge. To those who are content with the stamp of me- 
diocrity on their front, we have no reflections to offer ; but to 
the honest, zealous, progressive physician, we would confident- 
ly appeal. The elements of diagnosis derived from physical 
means, have now been systematized at least ten years ; they 
have been extensively adopted in Europe, as indispensable to 
whoever desires to understand the affections of the pulmonary 
and cardiac organs ; these affections are quite as frequuent and 
destructive in our c >uritry as in any on the globe ; why is it 
then, that we find those principles so reluctantly adopted among 
us 1 Shall it be said, that whilst every medical tyro in Europe 
can, with ease and certainty, distinguish the locality, extent and 
nature of every variety of thoracic disease, that there are but 
few practitioners in our country, who can distinguish pleurisy 
from pneumonia? Tubercular phthisis from mere catarrh? — 
The fact is too true ; and yet we know of no school in the union 
in which the principles of auscultation and percussion are prac- 
tically taught ! There can be but little doubt, that much of the 
apathy existing on this subject, is attributable to the prevalence 
of the same state of feeling among those who are ostensibly on 
the qui-vive for every information that can be of advantage to the 
profession. How can it be expected, that young physicians 
should strive to acquire that, which is of so little importance as 
not to merit the attention of their teachers ? We could not re- 
sist a sense of mortification, on hearing the acknowledgement 
made by one of the most distinguished teachers of the north, a 
few years since, when lecturing on pulmonary diseases, that Ik; 
could say nothing concerning the stethoscope, for he had thus 



$0 agnosia of Diseases of Vie Chest. [June, 

far d >ne v< ry well without it, and its use was foo troublesome 
cquire ! The influence of names unfortunately prevails to a 
I in the medical profession. In tne case just 
cited, how much error does it not cover! Auscultation will ne- 
ver become general, until it In* advocated by those at the head 
of the i i. T-he invaluable discdvery of lithotricy re- 

mained in Europe in the hands of its author exclusively for 
years. In cause Dupuytren preferred the knife. In this country 
its introduction was retarded until very recently, by an abortive 
attempt of one who, though deservedly pre-eminent, did not suf- 
ficiently study the new instruments placed in his hands. We 
sincerely hope, that the good sense of the profession will tri- 
umph over the vain authority of title, and that the stethoscope 
will, ere long, be deemed an essential part of every practition- 
er's outfit. 

That the little work of Dr. Gerhard, will do much to facilitate 

branch of the art of diagnosis? we can entertain no doubt. 

Its language is good, notwithstanding it is plain and intelligible 

English. Dr, Gf. appears carefully to have avoided any ofthajt 

irable pedantry, so commonly evinced by writers of.1 
day, who, forgetful or ignorant of the richness and cogency of 
our own language, continually resort to words of foreign origin. 
Although the subject of which he treats is peculiarly French, 
we find very f< w instances in which he has drawn on that lan- 
guage f r words to convey his ideas. 

The review of a manual is always an ungrateful perform- 
ance, not only to the reviewer, but also to the author, for it Is 
difficult to condense what has already been reduced to so small 
a compass, ;md it is no less difficult to do justice to the work 
by mere extracts; we shall therefore attempt simply to convey 
some idea of the contents of the volume before us. 

The history of the physical signs of disease, is premised by 
general remarks on the conformation of the chest, on percussion 
and oil auscultation. The rules laid down forexaming the tho- 
rax aie highly important. Its anterior, posterior, and two la- 
teral aspects, are successively studied in the normal state, and 
with reference to the changes they undergo by disease of the 
contained viscera. 

The third chapter is devoted principally to the manual per- 
formance of percussion, which " is mediate or immediate. Im- 
" mediate percussion requires the ends of the fingers, or in some 
" cases, their palmar surface to be struck quickly upon the walls 
u of the thorax. Tins mode of percussion was once generally 
"employed^ but h is now very properly and universally aban- 
doned, on account of the production of less sound than may 
"be obtained from mediate percussion, the greater pain caused 
" to the patient, and the absolute impossibility of using this me- 
u thod, when the cellular tissue is infiltrated with liquid or loader! 



183G.J biagnosis of Diseases of tk (I. :u 

- with fat. Mediate percussion was introduced by M. Piorry, 

•• now Physician to the Hotel Dieu, of i'aris. A dense resisting 
" body is placed in contact with the patient, and held with the 
>; fingers of the left hand, while percussion i • made upon it with 
* ; the right. The body interposed" between the fingers and the 
" skin, is called a pleximeter ; it may be a thin plate of tvory, 

- leather, or metal, or, what is generally most convenient, the; 
"fore-finger of the left hand. An excellent pleximcter is -i 
•• piece of caoutchouc, or common gum clastic about a quarter 
"of an inch thick, and tolerably firm. This pleximeter is Very 

- elastic* gives a good full sound, and prevents any pain 1.' 

• by the patient." 

We give the decided preference to the ivory plate, such as is 
attached to many of the stethoscopes now in use. The resist- 
ance of the caoutchouc varies very much according to Chan 
of temperature, and when yielding, it cannot be used in those 
instances in which percussion is attended with pain. 

,The chapter on auscultation is one of great interest, treating 
as it does, of the manner of using the stethoscope, and of the 
sounds detected in health and disease. " When the ear is ap- 
" plied to the chest of a person in good health, a faint rushing 
" sound is heard during the act of inspiration. When this sound 
" is carefully analyzed, it will be found to consist of two ele- 
" meats, more or less blended together. The first element, or 
" the blowing sound, is that produced by the air passing through 
' ; the bronchial tubes. It resembles the sound made in the mouth 
,J and fauces, when the air is quickly inhaled. It is heard most 
" distinctly at the root of thedungs, over the trachea, and near the 
•' clavicles, especially the right. The second sound is the soft 
" murmur caused by the expansion of the vesicles ; it is the best 
" characteristic of a healthy pulmonary tissue. This sound is 
" termed the vesicular murmur, or the vesicular respiration. 
" from its anatomical seat. It is best heard where the tissue of 
••' of the lungs contains the greatest number of vesicles and the 
" smallest bronchial tubes — that is, at the base of the lungs, In 
" the axilla, and at their anterior margin. The sound of expira- 
tion is much more feeble than that of inspiration, and in a 
ft healthy subject is almost confined to the parts where the first 
" or blowing sound is heard. It is short, feeble, blowing, and 
s not resemble the inspiratory murmur.'' 

These sounds present varieties dependent oil anatomical 
structure, on difference of age, and on peculiarity of constitu- 
te >n. Those resulting from disease are much more complicated, 
and are arranged in classes and subdivisions, as follows : — 1st. 
Increase and diminution of the normal sounds of respiration ; 2d. 
Increase of the blowing sound of respiration, withfeebli 
absence of respiratory murmur; 3d. Imperfect bronchial, or 
rude respiration. "In this variety, the blowin 



i 



► 



3<2 ''•'• - i Utz Cites! . [June. 

id is tn \\ than usual, and more pr-o 

icular murmur is stii) heard, and is usually more feeble than 
in a healthy lung ; in som • it; is louder, but h is a i 

soun ." Bronchia] respiration, in which "the v 

murmur disappears when the pulmonary tissue is perfectly in- 
durated, the blowing sounds are sttll heard; but much m 

irigly than iu a natural state. * * * * The sensation 
<• ■ nmuiflkatcd to the ear is thai of the air pj ssing through solid 
;, and not through the spongy tissue of the lungs." 5th. 
Strong bronchial or tubal respiration^ Here "the inspiration 
and expiration are not only strongly blowing, without the k i I 
trace of vesicular respiratiQn, but they are both very loud, and 

emble the sound which would be produced by some one 

ving strongly into the car." (>th. CaVernous espiration 
" differing from the tubal respiration in Being limited to a 
cumscribed portion of the lung, into which the air is heard to 
pass, and from which it is forcibly expelled." 7th. Amphoric 

riration. " As the air passes into cavities of very large si.. . 

it produces a sound not unlike that caused by blowing smartly 

a glass or metalic vessel." 

The second class of alterations of respiration comprises the 

accidental or adventitious sounds produced during the act of 

piration. These species of rattle are termed KhoncHi, and 
I >resent the following variety -s : 1 . The Cave? nous 1, Hon eh us, or 
gurgling, "is the loudest and most easily heard of all the humid 

nchi; the air passes through a liquid of moderate tenacity. 
contained in a cavity of a size varying from that of a sj 
almond to -i large orange, or in some oases ii nited only by die 
])lcura and the; thoracic pariet.es." 2. The r Macou,s Rhonchus " is 
analogous in character to the cavernous; it is more diffused, 
but less intense. It is produced, like the gurgling, by the pas- 

! of air through a liquid of little tenacity, but it must be con- 
tained in the larger bronchi, instead of a. circumscribed cavil)." 
3. The Crepitant lilionclms "is produced in the same bronchial 
ramifications, or, ;is some suppose, in the pulmonary vesicles ; 
and is caused by the passage of the air through a x^vy tenacious 
liquid. The bubbles are, therefore, much smaller, and break 
with a sharper noise than the mucous rhonchus." 4. Sub-crcpi- 
tant Rhonchus. " This variety is distinguished from the prece- 
ding, by the larger size of the bubbles, mad'* by the air passing 

lUgh the smaller bronchial lubes, and the greater quanti:; 
liquid. >). Sonorous Rhonchus, "This resembles the cooing of 
;i pigeon, or still more nearly the sound of the bass-string of a 
violin." 6, The Sibilant Rhonchus "resembles a tow whistle, 
and, like the sonorous rhonchus, is heard both in the inspiration 
and the expiration. '/. The Grating Sound "is caused by the 
friction of the two surfaci s "!' the pleura, lined with false mem- 
brane.-: up »n ea< h other* and is heard in the. hitter stage i <>!' pleu- 



1838.] Diagnosis of Diseases of the Chest. 33 

risy, when the more liquid, part of the effusion 1ms been absorb- 
ed. 8. Metallic Tinkling, "This is produced by the fall of a 

drop of liquid from the upper p.u't of a cavity, upon the surface 
of a liquid contained in it, which gives rise to a peculiar tink- 
ling sound, a little similar to that produced by striking a pin 
against a glass vessel."' 

Having described the sounds produced by respiration, our 
author passes to the consideration of the auscultation of the 
voice. The modifications of the vocal resonance, consequent 
on pulmonary disease, are enumerated under six heads, viz : 
I. Increased resonance. 2. Bronchophony, or "a variety of 
resonance of the voice, which is much louder and much more 
distinct than is ever heard : n a healthy lung." *3. Pectoriloquy, 
or " the resonance yielded by a cavity in the lung of moderate 
size. * * * The voice seems to proceed from the 
cavity and to enter the ear." 4. Amphoric resonance, when 
4i the voice seems more hollow, more distant, and more diffused 
than in Pectoriloquy." 5. Egophony. "When the voice is 
transmitted through a layer of liquid contained in the cavity of 
the pleura, it has a peculiar quivering intonation, resembling the 
bleating of a goat, or the voice heard through a speaking trum- 
pet." 6. Diminished resonance. 

The indications derived from the cough and expectoration 
arc sufficiently valuable to require some attention. The varie- 
ties of cough noticed are the short and dry, suppressed, sonorous, 
laryngeal, lo)sc mucous, hollow, and spasmodic. With regard 
to the expectoration, attention is directed to its quantity, colour, 
consistence, form, odour, and admixture with foreign matters. 

All these physical signs being well understood, it is easy to 
apply them to the diagnosis of the various forms of pulmonary 
disease. This is done by our author .with brevity and perspi- 
cuity. He successively passes in review Bronchitis, Emphy- 
sema, Pneumonia, Gangrene, Phthisis, Pulmonary Apoplexy, 
Pleur sy, Pneumo-thorax, and the tubercles of the bronchial 
glands. The limits assigned to this article preclude any details 
on these topics. 

The situation and action of the heart, render it peculiarly 
susceptible of study by auscultation and percussion. It is ob- 
served that, " as a portion of the pericardium, and consequently 
of the heart, is not covered by the lungs, percussion on the cor- 
responding part of the chest must yield a dull sound, because 
there is no lung and consequently no air benenth it ; that " in 
the normal state, the impulsion of the heart is felt opposite the 
cartilage of the the fifth rib, in a space about an inch square ;" 
that " by placing the ear near the heart of a healthy individual, 
we find that each pulsation is composed of two distinct sounds, ^^ 
which are followed by an interval of repose ;" that " the limit in a 
which these sounds are heard varies according to the dimensions 



')4 Tartar Kmciic in Obs&tfic Practice. [June* 

of the chest and the thickness of its walls;" and lastly, thai 
"besides the increase or diminution in the loudness of the two 
sounds yielded by the heart, they may be changed in character 
and tone. " 

The most common cardiac affections are Pericarditis, lesions' 
of the valves, Hypertrophy, and Dilatation ; all of which are 
more or less readily detected with a knowledge of the physical 
signs ; whereas, without them, a correct diagnosis cannot be 
obtained. 

Dr. G's work concludes with a chapter on the method of ac- 
quiring a knowledge of the physical signs, to which I would espe- 
cially call the attention of the reader. The method recommend- 
ed will enable any practitioner of observation and industry to 
render himself familiar with them in a comparatively short time. 

We cannot conclude this paper without testifying to the merit 
of the work of which we have given so imperfect a sketch. We 
have made no criticisms, because we have had no occasion to do 
so. The work, although a compilation from printed books, con- 
tains many valuable additions, derived from the researches of 
men still labouring in the cause of science, and who daily add to 
our fund of knowledge. The opportunities enjoyed in Europe 
and in this country by Dr. Gerhard, together with his known 
talents, zeal and industry, entitle his productions to especial dis- 
tinction. We wish his present work every success, and hope 
that its favourable reception may prove an incentive to further 
exertions. D. 

Augusta, May 10///, 1836% 



••' 



Observations on the use of Tartar Emetic m Obstetric Practice 
By Eyoky Kennedy, M. D. Master of the Lying-in Hospi- 
tal, Dublin. 

The following very interesting memoir we have read with 
great pleasure. The same pleasure we cannot withhold from 
those of our friends who may not have seen it. We value it 
no less for the candid, faithful spirit which it breathes through- 
out, and the excellent field of observation of which it is the 
gleaning, than the great importance of the cases to which it is 

o well calculated to bring consoling and salutary assistance. 

VVe designed%o make extracts of the most, valuable portions 



j 83G.] Tartar Emetic in Obstetric Practice. &T> 

for the benefit of our readers ; but on making the attempt, we 
find it impossible, in justice to the author, and to the cause of 
truth, to omit any part of it. We are highly gratified to find 
that so valuable a practitioner as Dr. Kennedy lias been so fa- 
vourably disposed towards American medical literature, as to 
make this communication directly to the American Journal. 
We understand, from a note of the Editor of the Journal, that 
Dr. K. is the author of a valuable work on auscultation. We 
hope it will not be long before we shall be enabled to enjoy the 
pleasure we feel warranted to expect from its pages. As we 
have not room in the present number for the whole essay, and 
as it may be divided without other injury than withholding a 
part for our next number, we shall give the first half only in the 
present. 

"If it be the duty of the hospital superintendent to avail himself of the op- 
portunities afforded him of investigating new and interesting plans of treat- 
ment, establishing what is correct and rejecting what is erroneous in prac- 
tice, it is equally his duty to afford the results of his investigation and 
experience to the public. The following observations assume to be, not 
merely the result of one or two experiments or accidental cases, but the 
report of practice adopted and tested by the experience of years in what will 
be admitted .a sufficient field of observation. The plan here followed of 
selecting a medicine and treating of its efficacy in several different diseases, 
may appear to some to savour of empiricism. The only motive for this 
variation from ordinary habit is brevity, a plea that has novelty as well as 
simplicity to recommend it to my readers. 

Tedious labour from Rigidity of the Os Uteri and Vagina. — Some patients 
continue for many hours in the first stage of labour, with partial dilatation 
of the os uteri and external parts, in whom there may be no want of what, 
are significantly termed grinding pains, a state more frequently met with in 
first pregnancies and those who marry late in life. This state is to be care- 
fully distinguished from false labour, which' it much resembles, by the partial 
dilatation of the os uteri, protrusion of the membranes, and presence of 
glairy discharge. It may continue for some hours, rendering the labour 
more tedious than it would otherwise have been, the parts eventually be- 
coming relaxed, and the labour terminating favourably ; it may continue for 
many hours, exciting our dread as to the result of the case : or, in its more 
obstinate forms, it may persist so long as to wear out the mother's strength 
in unavailing efforts to overcome the difficulty it opposes to delivery, the 
mother, child, or both, perhaps, falling a sacrifice. The difficulties to 
encounter here, are premature, too forcible or irregular uterine action, pro- 
pelling the child against the os uteri before it is sufficiently dilated or 
/lilatablc, and absolute rigidity of the parts. It should be constantly borne 
in mind that the first inconvenience is a very frequent cause of the second. 
With this view of the subject, then, the two objects to be held in view, are, 
mitigating too early, violent, or irregular uterine action when this is the 
cause of delay, and producing relaxation when rigidity is present. Of the 
efficacy of tartar emetic in producing the first effect, we shall presently 
treat, when on the subject of violent labour ; for the present let us inquire 
into its utility in the second. In tedious labour, from rigidity of the uterus, 
the os is found slightly gaping, with a thickened, tense state of the lips, nnd 
usually much heat of the parts. Bleeding from the arm, and, on the eonti- 
nent, the use of the warm bath, have been had recourse to in these cases 



i 



> 



36 Tartar Emetic in Obstetric Practice, [June, 

Bleeding is attended with marked benefit when there is a full bounding 
pulse, in a strong plethoric habit; but, as a general practice, it is not unin- 
tended with inconveniences, often of a very serious nature. It. certainly 

procures relaxation of the os uteri, but along with this it causes depres - 
of too permanent a nature, and may thus seriously interfere with the future- 
progress of the labour. Tartar emetic solution has been successfully em- 
ployed in producing relaxation of the os uteri in these cases, and poj s< 
the advantage of being much less permanently debilitating. It is an agent 
by which the system can be with safety brought into a much greater degree 
of temporary depression; between which state and relaxation of the con- 
tractile tissues, a marked connection holds, if they do not absolutely stand in 
the relation of cause and effect. The principal'recommendation, however, 
to tartar emetic in these cases is, that in its use, the power of regelating the 
necessary degree of lowering the system, exists completely in the hands of 
the practitioner, as he has only to increase, or diminish, or suspend the dose r 
in order to produce the effect he wishes; and, when the we ssary effect Is 
produced, the withdrawal of the medicine leaves the vital energies but little 
impaired. The medicine has been used in the ordinary nauseating doses, as 
in pneumonia, 5 or grains of the tartrate of antimony, dissolved in e . 
ounces of water, and generally 20 drops of laudanum, and a small quantity 
of syrup added; one, two, or more table-spoonsful of this mixture are giv< n 
at intervals of from fifteen minutes to two, three, or four houTs, according to 
the effect it produces, and the necessity that exists for bringing the patienl 
speedily or otherwise under its influence. Sometimes it is necessary to 
cause irec vomiting in the first instance, or the ordinary doses produce no 
nauseating effect ; in such cases the laudanum is better wit hheld, but may be 
added afterwards if necessary. In other cases the medicine acts too vio- 
lently as an emetic, or produces purging; here increasing the quantity of 
the laudanum, and diminishing the dose, or allowing a longer interval to 
intervene between the doses r will be necessary. The accoucheur must, 
therefore, watch carefully the effects of the medicine during its administra- 
tion in every case in which it is employed ; these observations applying with 
equal force to the forms of disease m which its utility has been proved. 
Under some of the circumstances described, or where the antimonial in 
every dose and form disagreed with the patient, small and frequently repeat- 
ed doses of hippo [ipecac] have been substituted (three to five grams every 
how or second hour,) and with good effect, not only in rigidity of the uterus T 
mil in the other diseases in which tartar emetic w;is found efficacious. It 
should be mentioned, that neither tartar emetic nor venesection have been 
relied upon singly in some cases where it lias been necessary to produce 
speedy dilatation of the os uteri, and where the plethoric state of the sys- 
i< m described was present. In such, after depletion, the patient, was kept 
for some hours under the influence of the nauseating mixture. One ci Be, 
in particular, of a most threatening nature, maybe mentioned, in which a 
strong, robusl woman was brought into the hospital with the arm forced 
into the vagina, through a tense, rigid, and slightly dilated os uteri. She 
was so treated, and with the besl results. T*here is a Bomewhat different 
• of the os nti ri, in which it occai kmally dilates very tardily also; here 
the lip of the uterus is thin and stretched over the head of the child, not 
a'i'. -ding the sensation of heal or rigidity of fibre observed in the case abov< 
d< scribed. The extract of belladonna appeared of service in afewofthesi 
c ■- j, al hough its general efficacy appeared very questionable. In two 
( - of rigid os uteri, in which it was freely \\^c(], its application was fol- 
1 wed I v head symptoms and depression of pulse; in one of which even 
i isibility and stertor were present. It was, however, tried in many other 
9, without being followed by these unuleasant effects. The last described 

stt '" of the os uteri is also occasionally benefitted by the nauseating medi- 
c Tt may depend, however,. upon other causes, not under our present 

consideration, nor is ft looked upon with the same anxiety by the occouch- 



1836.] Tartar Emetic in Obstetric Practice. 37 

rur as a cause of tedious labour.* In concluding this branch of our sub] 
not be inferred from what lias preceded, that tartar emetic will b 
eceedin procuring dilatation of the os uteri; as it is in some ci 
" unavailing, in others inadmissible. Its efficacy, however, in a 
: which it has been used, fully warrants its attracting the 
dtion of the obstetrician, and its success will depend much 0:1 a proper 
selection being made of the cases in which it is available. 

Irritable or Violent Labour. — By no means an unfrequent eauee <»! tedious 
IT is extreme irritability or violence on the part of the mother, a state 
frequently met with in first children, and in the lower ranks, but not 
confined to these. The patient, from the very -commencement of her labour, 
becomes violent and irritable, -keeps constantly changing her posture, and, if 
■d, tossing about ;• is generally very violent and vociferous, and, when the 
pain is present, bec9mes absolutely uncontrollable. By this means she loses 
the effect of her uterine efforts— she don't wait for these to bear down, but 
keeps up a continued and unavailing straining at expulsion in their absence, 
and, when they are present, she becomes violently restless, and forcibly and 
suddenly inspires, in place of fixing her respiratory muscles to assist in expul- 
sive efforts which would now prove availing. This state may continue for 
many hours, or even for days, with more or less complete dilatation of the os 
uteri, and with little or no advance of the child through the pelvis; the pa- 
tient at length becomes fatigued. The irritation and restlessness continue, 
bur the uterine efforts cease, and exhaustion setting in, we are obliged to 
have recourse to instruments to effect the delivery. In some, the os uteri 
is not even fully dilated at the period when force delivery becomes necessary, 
and the crotchet is^then the only instrument available. In protracted violent 
labour, however, the child is dead in the great proportion before delivery, 
from the delay and violence of the parent. In these patients, where the 
pulse is full and the habit plethoric, venesection is often of service. The 
advantages that the use of tartar emetic off red in the cases already treat- 
ed of, recommend it even more strongly to our notice in this. Long conti- 
nued observation of its utility in cases of this kind, and the having found it 

* In this species of rigidity, we have always succeeded in effecting the 
desired dilatation by the fingers ; and more speedily than might general!} 
be expected by the relaxing power of the antimonial, or of the Dilating 
Pomade (Belladonna Ointment.) Only three days since, we were called to 
a case of protracted labour, in which the woman had suffered the most se- 
vere pains which ordinarily attend the first stage of labour, more than 30 
hours. The labour was every way regular, for the first stage, except that 
no dilatation whatever had been produced. From the exhausting power of 
continued severe labour, her strength was much impaired, and the pains 
had become comparatively weak. On examination, the parietes of the 
uterus were so attenuated that the midwife doubtless had mistaken them 
for the membranes covering the head. But on reaching back to the hollow 
of the sacrum, the os uteri was found thin, but so closed that the point of one 
finger could not be made to touch the membranes through it for many 
minutes. So strong was the contraction, that after the finger was passed 
into it, it caused not a little pain by its tension around the first joint of the fin- 
ger. Soon, however, the end of another finger was passed — then a third ; 
and without other means the dilatation was effected, and the woman con- 
ducted through the third stage of labour, and placed comfortably in bed, 
within two hours from our arrival. — [Ed. 



38 Tartar Em tic in Obstetric Practice. [June. 

procure the double effect 6f dilating the os uteri and softs parts, and sus- 
the irritability and violence which so much interfered with the na- 
tural progress of the Labour, have convinced me, that by its lull admimstra- 
. in the cases described, we may often enable a woman to be speedily 

;\m\ safely delivered by her own efforts, who, without it, would have suffered 
from a tedious and dangerous labour, eventually, perhaps, requiring the use 
of instruments. To produce any good effect, it must be freely administered, 
the patient brought completely under its influence* and retained so whilst 
any tendency to irritability or violence remains; nor does it appear to sus- 
pend the labour altogether, as might be supposed; it merely mitigates or 
regulates the violence of the pains, and under its use the labour progresses, 
and the head advances into the pelvis. Tt should not, however, be persisted 
in so long as to reduce the powers of the patient too much; it should be 
discontinued when we have attained our object, quieting the patient. — 
These observations will also hold as to its utility and application in the cases 
alluded to at the commencement of this paper, where the os uteri remains 
undilatod from the occurrence of premature, forcible or irregular uterine and 
abdominal efforts. 

Puerperal Convulsions. — The efficacy of tartar emetic in puerperal con- 
vulsions, is quite as marked as in the preceding cases. It should, however, 
be understood, that it has not been used to the total preclusion of bleeding, 
which must always prove our sheet anchor in this violent disease. It r< n- 
ders unnecessary the repeated bleedings we have hitherto been obliged to 
have recourse to, as the only effectual means of checking or preventing the 
repetition of the fits. After one copious bleeding, the tartar emetic is to be 
freely administered, as already explained, and the patient kept well under 
its influence. The return of the fits will by this means, in the great ma io- 
rity of cases, be prevented; and even in the most obstinate cases, they will 
be lessened in their severity and frequency. Its administration must not 
he desisted from until the patient is delivered, unless it produces too great 
prostration, even in diminished doses ; neither is its use to preclude a repe- 
tition of the venesection, if symptoms should be sufficiently urgent to require 
this; nor the use of such other local or ordinary means of treatment as are 
generally had recourse to. There is a form of v puerperal convulsions, in 
Avhich neither this nauseating plan of treatment nor free depletion afford the 
benefit generally derived from them; on the contrary, the disease appears 
to be aggravated by these. A remarkable case of this kind occurred some 
months since in the Hospital, in which, after the patient, undergoing the or- 
deal of depletion, the nauseating mixture, as well as purgatives, shaving and 
cold applications to the head, sinapisms to the feet, blistering, and so forth, 
the disease was becoming more and more violent under their use, when she 
was put freely and rapidly under the influence of opium, and with almost 
magical effect. It would, however, be wandering from the original plan of 
tins paper, to go further into the subjects treated of, than in connexion with 
1he use of tartar emetic in them ; we shall, therefore, only add, that this me- 
dicine is admissible and eminently useful in all cases of puerperal convul? 
. ions, in which depletion proves serviceable. 



183<).] On Creosote. 80 

[ Extract from the Mcdico-Chirurgical 1U \ Lew, tfo. 62, page 1 H. I 
Oa " Crrosomy 

As this powerful stranger, which has lately made its way into therapeul 
is occasioning considerable curiosity, we shall here introduce an account of 
its properties, mode of preparation, and medicinal agency, from a recent 
edition of Dr. Gully's "-Formulary of New Medicines," published by 
Churchill. 

"The name of this remedy is derived from the Greek, ^p/a.c, flesh, and 
tfw£w, to' preserve. It was discovered last year by M. Reichenbach de 
RLansko, in pyroligenous acid, in the first instance, and subsequently in the 
diil' rent kinds of tar. ' 

In the process which led to the discovery of creosote, M. Reichenbach 
fou id that his fingers were deprived of their epidermis, and he conjectured, 
from this vehement action on organic matter, that this substance might be 
the mummifying principle of pyroligneous acid, and. might also serve an im- 
portant therapeutical purpose in the living body. This explanation hafl 
since been realized. 

Physical Properties of Creosote. 

Creosote is an oily, colourless, transparent liquid, of a penetrating odour, 
resembling that of smoke, or smoked meat, and of a burning and exceedingly 
caustic taste. It has a specific gravity of 1,037. 

Chemical Properties. 

It boils at 203° Centigrade, and is not congealed by a cold of — 27° C. 
It burns with a strong fuliginous flame. Witfy water at 20°, it forms two 
combinations, one a solution of one part in 80, and the other of 10 parts in 
100. This aqueous solution does not change turnsol, nor is it neutralized by 
acids or alkalis. Nitric acid causes red vapours. A small portion of con- 
centrated sulphuric acid turns it red, but a larger quantity blackens it, the 
acid itself being also decomposed. Acetic acid seems to be its specific sol- 
vent, for it holds any quantity of it. All the acids, even the carbonic, separate 
creosote from its combinations with potass and soda, without otherwise af- 
fecting it. It dissolves a great number of salts, some with and some without 
heat. Alcohol, ether, carburetted sulphur, and acetic ether, combine with 
it in any proportion. It decomposes or dissolves resins, resinous colouring 
matters, and other similar substances. 

Shaken with white of egg y coagulation immediately takes place. Fresh 
meat, soaked for an hour in a solution of creosote, and then dried, may be 
exposed to the sun, without fear of putrefaction ; in a week it becomes 
hard, has the smell of smoked meat, and becomes reddish brown. Fish may 
be preserved in the same manner. Birds poisoned with creosote, remain 
nearly two months without emitting any putrid odour. 

These effects on animal matter closely resemble those of pyroligenous 
acid and tar-water, and demonstrate almost to a certainty that creosote is 
the preservative principle of those fluids. This, however, has been further 
shown by the extraction of creosote from both of them. I shall confine 
myself to the preparation of creosote from tar, as it is procured more abun- 
dantly, and by an easier process, from that substance. 

Preparation of Creosote. 

In the dry distillation of tar from wood, the fluid collected in the receivers 
contains an empyreumatic acid water, which is rejected, and oil of tar, 



10 On Greosote. [June 

which is placed in glass retorts and rectified. In these two distillations the 
oil of tar is at firsl light, but as the heat is ufpreased, its gravity ai 
\t one period of the process the oil sinks to the bo torn, and atliiid whicl 
hi creosote, and consists mostly of eupione, and other substances th A 
fere with the purity of the creosote, floats above it: this 
and the pale yellow tar-oil is heated. Carbonate oi potass is .... 
the carbonic acid is no longer 'disengaged on shaking; the mixtur . d 

in order to separate the acetate of potass, and the oil is again distilk d 
glass retort, and all the first products thai float on the water are rejei 

oil is then dissolved ma solution of caustic potass of the epecifi* 
1,12; heat is thereby developed, and a portion of the materials cod 
eupione, &c. not being dissolved, floats on the surface, and is remov< . 
alkaline solution is poured intjo an ojion capsule, and regularly heated to 
boiling. It rapidly absorbs the oxygen of the atmosphere, whereb] 
liar oxidizablc principle-in it is decomposed, and the mixture thou - 

brown. After cooling in the open air, diluted sulphuric acid is added until 
the oil is set at liberty. It is then distilled with water, holding a little c 
tic potass, and the whole is kept boiling until the quantity of oil whic] 
scs from the retort becomes diminished ; at this point the distillation si odd 
cease. The oil and water in the receiver are again distilled with po1 
and the same treatment with sulphuric acid repeated, as in the former 
stance. A third distillation is then made, and a little phosphoric instead of 
sulphuric acid is added, in order to take up some ammonia retained in the 
oil. 

The oil is then for the third time dissolved in caustic potass, and if the 
preceding processes have been carefully managed, they combine, v it] i ut 
leaving any residue of eupione, and the mixture, on exposure to the ; :r, 
docs not turn brown, but takes on a slightly reddish tint. As long, liov e- 
ver, as any eupione remains, and the mixture turns brown, the solution in 
potass should be repeated. In this state, the creosote is not entirely pure, 
but it may be used for medicinal purposes. 

It may be obtained perfectly pure by distilling it with water alone, 
rectifying the product of the distillation repeatedly, until no water p; 
When the heat is raised to 203° C. The last product is creosote unalloyed 
by cupiono, picamaro, water, or other matters. 

M. lloichenbach endeavoured to simplify this tedious process; but he 
found that the product was always unfit for internal use, while its action on 
the surface was much impaired. So procured, its emetic effects were most 
violent; a single drop applied to the tongue, caused, in the space of a minute, 
excessive nausea, with tremors, succeeded by vomiting and great prostration 
of the powers. These effects he attributes to the presence of eupiom , and 
he therefore recommends the process above described to be followed on all 
occasions. 

Physiological Action of Creosote. 

Applied on tin 1 tongue in a concentrated form, creosote causes violent^ 
pain, though no redness or tumefaction is present : a strong taste of smoke 
extends 1() t' 1( ' throat. Toured on the skin, it produces a burning sensation, 
with rubefaetion and erosion. 

Flies, spiders, and small fishes die in ihe course of two minutes, when 
immersed in a solution of twelve drops of creosote, in two ounces of wati r. 

Two drachms, given in half an ounce of water to a puppy dog, induced 
the following symptoms: complete prostration of muscular power, drooping 
of the head, fixation of the eyes, vertigo, apparent stupefaction of all the 
senses; the respiration, from being laboured, was at the end of three 
minutes almost entirely stopped by an abundant secretion of viscid, filamen- 
tous mucus; to which was added vomiting of whitish milkv fluid, with so 18- 
q die contraction ol the abdominal muscles. These symptoms got gradually 



1836..] On Creosote. 41 

-e for two hours, th ! respiration becoming more laborious, and at longer 
,als, ili.' limbs being seized with tremor?, then with convulsive contrac- 
tions, and the whole ending in dfeath. 

( ) 1 opening the body of the animal, all the tissues of the body, except the 
liver, exhaled a strong odour of creosote. The mucous digestive mem- 
brane gave sighs of inflammation throughout its whole extent; the matters 
contained in the stomach coagulated white of egg, and heated, gave out the 
powerful tar-smell of creosote. In the heart and the immediate great ves- 
sels, the blood appeared to be much more firmly coagulated than usual. — 
lungs were gorged o^er the greater part of the extent with reddish- 
brown blood; the more ruddy parts of them floated in water readily: the 
darker portions scarcely swam at all. No sign of congestion about the 
brain appeared. 

On injecting equal parts of creosote and water into the carotid artery of a 
dog, the same symptoms w r ere produced, but death ensued more speedily. 

If concentrated or diluted creosote be added to blood, the latter thickens 
and becomes reddish brown, with small spots of white, probable coagulated 
albumen : on further exposure to the air, the blood passes to a yellowish-red 
colour. 

The signs of poisoning with creosote, therefore, are the redness of the 
gastrointestinal mucous membrane, the peculiar thickness and colour of 
the blood, the property possessed by the matters in the stomach of coagu- 
lating albumen, and more especially' the peculiar odour exhaled by all the 
tissues of the body. 

Plants watered with a solution of creosote, fade and die in the course of a 
few days. 

Medicinal Employment. 

M. Reichcnbach's first essays of his newly-discovered remedy were made 
on slight burns, infantile excoriations, and wounds. Subsequently he was 
induced to try it "in extensive burns by hot iron and boiling fluids : in itch 
and various kinds of tetters : in gangrene consequent on extensive com- 
pound fracture of the leg : in caries of the phalanges of the fingers and toes : 
in tooth-ache, though it fails to put a stop to the caries of the tooth : in 
open, fungous whitlow : in scrofulous ulcers of the throat, leg, and joints of 
the fingers : in ulcerated white-swelling of the knee of two years' standing : 
•;i chancres and other syphilitic ulcers: in wounds from cutting and piercing 
instruments, caustic alkalis, &c, in which cases the wounds did not cure by 
suppuration, but by actual desiccation caused by the creosote. In all these 
instances he has found the remedy most effectual and astonishingly rapid in 
its operation. Thus in a case of old-standing and scrofulous ulceration of 
the throat, with purulent discharge from the ears, the ointment of creosote 
to the former, and the injection of creosote water into the latter, put an end 
to both in the course of three weeks. 

Internally, M. Reichenbach has given it in several cases of hemoptysis ; 
in two of these, the sanguineous expectoration had continued for upwards of 
a week, when the administration of four drops of creosote, on sugar, daily 
for four days, arrested the flow of blood. . 

Turning to the practice of the French physicians, we find that creosote 
has been successfully employed in burns by Berthelot and Goupil, who ob- 
serve, that in treating these with creosote, the tendency to cicatrize from 
the circumference to the centre, and the consequent contractions and irre- 
gularities, are avoided ; in various dry and moist tetters by Goupil, Coster, 
Berthelot, Martin-Solon, Duchesnc-Duparc and Dauvergne; in chancres 
and old venereal ulcers, by Kiinckel, Lessere, and others ; in sanious ulcer- 
ation of the cervix uteri, by Colombat; m a cancerous ulcer of the nose, 
by Breschet ; in chronic inflammation with suppuration of the edges of the 
Jids, by Coster; in cancer of the womb, by Hvppolvte Cloquet andTea- 
6 



42 On Creosote. [June. 



lier ; in varicose, ill-conditioned ulcers of the leg, by Goupil, &c. Chilblains 
are also considerably benefited by frictions, with creosote ointment or water. 
M. Regnart, of Paris, among many other patients, had the good fortune to 
relieve the gifted Broussais from an excruciating tooth-ache, by the free 
application of concentrated creosote to the carious tooth ; we cannot won- 
der that the worthy professor should be an advocate of the doctrine of 
* irritation.' 

As this application of creosote may be of more extensive and familiar use 
than many others, it may be well to inquire how it acts as a sedative in this 
instance. When the teeth are painful it is almost always because the nervous 
pulp near the root is exposed to the contact of the air. If in this circum- 
stance a few drops of undiluted creosote are applied, a fierce increase of pain 
is the first effect, then a total cessation of it : in this, either the nervous puip 
is destroyed as by some caustic, or the creosote, by coagulating the albumen 
of the fluids that are always flowing from the caries, forms an albuminous 
layer that defends the pulp from the air ; or, lastly, it acts as a powerful 
stimulant, causing the inflamed vessels of the pulp to contract and expel the 
load of blood by which they are oppressed. In any case the pain is apt to 
return, and this fact is only explicable by one of the two latter suppositions ; 
for so long as the irritating cause, carious bone, remains, so long are the 
vessels of the pulp liable to relapse into their former congestion. 

Creosote has been employed by the French physicians in pulmonary phthi- 
sis, but. from all that I have read on the subject, the alleged successful cases 
are strained, and should not be recorded as such. It has not been more suc- 
cessfully used in several Cases of chronic bronchitis by inhalation. 

British practitioners have not as yet essayed the effects of creosote, and 
indeed this is too often the case with regard to new remedies. My friend, 
Dr. Copland, however, is an exception to this rule ; lie tells me he has em- 
ployed it m cachectic affections as a tonic, and also in dropsical cases, 
where it has proved diuretic. In two cases of diabetes, he considers that 
he was not allowed to make a fair trial of it. The dose he gives is generally 
from one to eight minims three or four times a day, combined with powdered 
liquorice root, into pills. In porrigo favosa, he has used a lotion of saturated 
solution of creosote with good effect. 

My own experience of the effects of creosote is as yet confined to cases of 
scrofulous ulcers of the leg, tooth-ache, lumbago, and aphthae. In the first 
case, of ulcers, I premised a seton in the arm, and the rapid desiccation of 
the ulcers caused by the creosote had no ill consequence on the brain or 
any other viscus. In tooth-ache I have verified the reports above alluded 
to. In the case of rheumatism I found the remedy at first produce distress- 
ing nausea, but the warm and copious sweat that ensued soon compensated 
for that symptom, and effectually removed the rheumatic pain ; copious diu- 
resis was also one of its effects. 

In a case of extensive apthous ulceration of the mouth occurring in an 
adult, I employed the following wash with the greatest advantage; the 
sloughs came away after the second time of washing, and the depressions 
in the mucous membrane filled up with astonishing rapidity ; several of the 
ulcerated surfaces were as large as half of a sixpence : 

Creosote, 1-2 a drachm ; Gum Arabic Mucilage, 1 1-2 ounce ; Camphor 
Mixture, 10 1-2 ounces. Mix. To wash the mouth every two hours. 

Mode of administering Ci'eosote. 

■ M. Reichenbach says, that his observations demonstrate that in the cure 
of certain ulcers-, tetters and wounds, creosote water was sufficient. But it. 
should be remembered that water does not dissolve more than about 1-S0th 
of creosote — a proportion that will be found inefficient in the generality oi 
obstinate cases of ulceration. In such instances the employment of pure 
creosote becomes necessary, 



1 630.] On Creosote. 43 

The application of concentrated creosote to ulcers, causes, in the first 
instance, more or less of inflammation, which, however, quickly subsides ; 
as soon as this inflammation appears, the remedy should be discontinued for 
a few days, and the wounds allowed to remain quiet. The application is 
then renewed with similar consequences; and this is repeated until the bad 
condition of the ulcer is changed, that is, until the greenish pus becomes 
white, the blue or white flesh becomes red, and firm granulations fill up the. 
solution of continuity. Creosote should therefore be employed more freely 
at tiie commencement than at the close of the treatment of these cases. 
When the ulcer has taken on the appearance above described, it will suffice 
to dress it with the creosote ointment, or water, or even desist altogether 
from its use, and introduce other desiccating remedies. 

The best mode of applying it, is by means of a camel-hair brush to paint 
the surface of the sore ; or from five to a dozen drops may be placed on the 
surface of a poultice, and this applied over the diseased point. 

When used to stop external hgemorrhages, it may be poured by drops into 
the wound ; but in these cases it seems to act with more certainty if imbibed 
by cotton or lint, and thus applied. 

To form a lotion for the employment of frictions, from two to eight drops 
are added to each ounce of distilled water. Creosote ointment is made of 
ten drops of that substance and one ounce of lard : it may be used either to 
dress ulcers or to rub into the sound substance. 

The internal administration is either in draught or pill ; the former being 
composed of one or two drops of creosote dissolved in camphor mixture ; the 
latter of the same quantity and some absorbent powder with mucilage. This 
dose may be repeated three or four times a day, and may gradually be in- 
creased to eight drops. 

The inhalation of creosote is effected, first, by steeping paper in it and 
placing this in approximation with the nostrils ; next, by heating the creosote 
in the immediate neighbourhood of the patient, so that lie cannot fail to 
inhale the fumes ; or, lastly, a portion of it may be poured into hot water in 
a Mudge's inhaler, and the creosoted vapour inspired in the usual manner. 

It should not be continued internally for too long a period, for it is apt to 
produce irritation of the system and pains of the stomach and intestines. 
Demulcents should accompany its employment, and should occasionally re- 
place it. 

From all that I have advanced concerning the therapeutical properties of 
creosote, the following general conclusions may be made. 

1. That creosote is beneficial in the different stages of burns. 

2. It cures the majority of herpetic, furfuraceous, squamous, and crusta- 
ceous skin diseases. 

3. It cicatrizes obstinate syphilitic ulcers, prevents or diminishes suppu- 
ration, and destroys the fungous growth without injuring the surrounding 
tissues. It also corrects the condition of cancerous ulceration. 

4. In phthisis and bronchitis, though it fails to cure either, it facilitates 
greatly the expectoration. 

5. Chronic lymphatic tumours are frequently dispersed by frictions or 
fomentations of creosote. 

6. It is almost always successful in allaying the pain of carious teeth, but 
does not prevent its return or the progress of the caries. 

7. It arrests capillary haemorrhage with remarkable certainty, but fails in 
that from the large vessels. 

8. It is an effectual remedy in atonic rheumatism, and may be tried with 
-chance of success in cachectic disorders." 



4-1 Causf qj [June, 

[From the Medico-Chirurgical Review, Oct. IS35i I 
The Cause of Sleep, 

Many of our readers arc aware that a sharp controversj has existed, for 

gome tunc pai t, between Messrs. Macnish ami CarmichaeJ, respecting the 
cause ol' sleep. The following extract embodies the chief points of Mr. Car- 
michael's doctrine. 

"The absorbents and secerning vessels never remit, their offices — those 
carrying off the old particles from every part of the frame, and these d< ] o- 
siting new ones in their place; the absorbents being most busy with ihe 
muscular fibres, which are most exercised by labour, or the nervous fibres 
most exercised by the operations of sensation, volition, and thought. Vet 
these fibres, so exercised, are always the strongest and most powerful oj 
their kind in the frame: the secerning vessels mi;; ! therefore be equal!;, 
busy in restoring new particles in the place of the old, or during certain in- 
fo n als, rather more busy, because more are restored than are taken a v 
as is proved by the increase of size, proportioned to the occasional or 1 
tual exercise of the parts. Yet it is evident that it is not during the mo- 
ments of exercise that the great mass of new matter is deposited, other 
tii" muscular and nervous fibres in question would go on thickening and 
strengthening, the longer the exercise of labour and thought was continued ; 
and this, we know, is contrary to fact; — fatigue ensues, and rest is neces- 
sary, and during that rest it is probable that the secerning vessels, though 
always depositing new particles 3 , deposit much more, or the absorbents 
remove much less, than at other times. By rv?\, J mean a mere cessation 
from labour; and such rest is not sleep. The large mass of new particles 
deposited on t lie muscles cannot affect their tough and insensible fibres by 
any striking phenomenon : but when such a mass is deposited on the deli- 
cate, tender, and sensible structure of the brain and nerve?, how differenl 
must be the effect. If small in quantity, and while these organs are in a 
state of active energy, it may be hurried unobserved into the existing acti- 
vity of the living matter; but if large in quantity, and while the- 
are resting from their labours, can it be that the extraneous and unassimila- 
ted mass does not press its increasing weight on their fragile machinery, and 
produce an effect somet! ing like the pressure of the over-swollen blood- 
vessels, but natural, necessary, and healthful — the paralysis, not of apo- 
. Ir.it of sleep? 

While the incumbent mass thus paralyses the vncephahn, the body is 

•rless ; there is no voluntary motion, no perception, no thought, no 

m. But when the assimilation is complete in any one of the organs el 

the mind, then thoughts arise; but there is no perception until the assinii- 

omplete in one or more of the organs of the senses; until 

then the simple current of our thoughts constitutes an ordinary dream. 

If the nerves of motion continue invested in a newly deposited mass o! 
nervous matter, while the mind anxiously desires and essays in vain to 
move the/limbs — this is nightmare. It these nerves are extricated fitom 
th< ir trammels, - of the mind still continue — ■ 

they command ■i\i\ the nerves obey — this is somnambulism, lhit t) 
dreams, whether ordinary and natural, or attended with the horrors t I 
i ' mare or the perils of somnambulism, vanish as our Benses admit the 
impressions of the external world. We are then awake; but-wKile thus 
awake, if the nerves of motion are still aBleep — if their trammels still conti- 
upon them — tins is the daynktre, so feelingly described by Air. Macnish. 
If through any idioe ol assimilation were never suffi- 

c otly considerable to paralyze, by the mass of new particles, the brain and 
nerves of sense, the individual would exist as one that never flept, even 



1830.] Cau&p'of 



though his d srvous system Bhould ab1 in, in some < 
which are the peculiar concouul 

•if. I , through an oj pos i jy, the depo- 

i ii of d s should be so .- to continue 

the p ' nd oaturaJ period of i lumb r, thii 

would present- the rare and hith< is phenomena of prot 

terminating even in death, as in the case of Elizabeth Per- 
l by Mr? Macnieh. I > opposite idiosyncras 

arise from opposite diseases of the secerning vessels of the head, one pro- 
• to excess, and tin 1 other in an equal degree preventing, the effusion 
of the due quantity of ri i * the b salthy and vigorous 

if Mr nervous system. 
If it should be asked, How can the same cause operate in different waj s .' 
H \. ■(•■ ting process at one time cause sleep, and another not 

cause^t I How can it, though unremitting in activity, at one time paralyze 
the brain and nerves, and at another rather enliven and invigorate them.' — 
questions are difficult, and the more difficult because, m the material 
world, we can find no object wherewith to compare and illustrate the phe- 
nomena of mind. The clement of fire must suffice on the present occa- 
sion, where no better ligament of analogy between tilings so different can 
be had : — 

* Nutritnr ventis, ventis extinguitur ignis ; 
Levis alit flammas, grandior, aura nee at.' 

If a fire burns clearly, brightly, and fiercely, still it requires a constant sup- 
ply of fuel to keep up its intensity, and replace the solid particles expended 
m combustion, A small quantity frequently added, so far from paralyzing, 
increases the activity of the fire : but when that activity is exhausted, when 
the very energy of the rl lines, like the exertion of a powerful mind, has 
w isted away the substance on which it fed and these flames sink enfeebled 
and the fire is diminished and dull, if you heap over it a heavy mass of fuel, 
the flames are smothered, the activity ceases, the element sleeps. Hours 
are' required to extend the vivifying influence to the new matter ; at length 
the increasing warmth pervades the . whole mass, the assimilation is com- 
plete, and the smallest incitement stirs up again all the energies of the fur- 
nace. If too little aliment be supplied to the glowing mas?, it will burn out 
like an over worked brain in similar circumstances ; while too great a 
weight of fuel cast on the exhausted hearth overwhelms the expiring em- 
bers, and the result is the slumber of death, not of sleep."* 

The hypothesis (for we believe it may be considered only as hypothesis) 
of Mr. Carmichael is ingenious — perhaps it may be true. The laws of al- 
ternate sleep and activity, like all the laws imposed on us by the Creator, 
are, no doubt, the wisest and the best that could be devised. We can 
trace the operations of many of them — but very few of them can we ex- 
plain. It strikes us that there are some difficulties in the way of Mr. Car- 
michael's explanation of the causes of sleep. If this image of death be 
occasioned by the deposition of large masses of new matter on the delicate 
organization of the brain and nerves, inducing the "paralysis of sleep, it is 
curious how the bile of a Ilea or a bug will often disperse all these depositions, 
and start us into wakefulness ! It is also curious that all animals become 
more or less sleepy, during the very first process of digestion, in the stomach 
and long before assimilation, much less deposition of assimilated matters, 
can possibly commence. The dog, the hog, and the glutton fall fast asleep 
as soon as the stomach is crammed to satiety. They are most awake and 
active after digestion, and when assimUation, secretion, &c. arc in full play. 

* The Phrenological Journal, June 1, 1835, 



16 On ■! of the Vena Porta. (June. 
# L 

le cold and hunger induce an almost irresistible pro- 
is arise from depositions of matters on the brain 
:i- wal of their parte and powers .' 
[I . •■ ry tiling is periodical or alternate in this world, 

and nothing cons! . . m for a short time. The muscles cannot 

- be in a state of contraction. The brain cannot always be flunking. 
But the organ of the mind cannot cease to think, except through the mys- 
p — and, therefore, sleep was brd lined. How it is in- 
duced we know not. Opium will often lull to repose by diminishing sensi- 
; but still we arc totally ignorant how the sleep is produced in conse- 
quence. We must, therefore — 

"Wait the great teacher Death, and God adore." 



[Prom the American. Journal, Feb. 1830.} 
PkyswlogicQl and Chemical Researches on the Blood of the Vena Porta. 

The first No. of the forty-fourth volume of Rust's Magasin contains an 
account of some highly interesting researches by Professor Schultz, respect- 
ing the chemical and physiological differences between the blood of the ve- 
na" porta, and that of the arteries and other veins. The following is a suc- 
cinct summary of the results, as given in the Gazette Med. de Paris, (15th 
August, 1885.) 

1st. The blood of the vena porta is in general blacker than other venous 
blood, although this difference is not always manifest to the sight : it is not 
reddened by the neutral salts, or exposure to the atmosphere, or by the ac- 
tion of oxygen. 

2nd. The blood of the vena porta-dOes not generally coagulate, but when 
it does, the coagula are less firm than those of the other arteries. In those 
cases in which it has coagulated, it liquifies entirely or partly at the end of 
from twelve to twenty-four hours, and produces, as well as that which docs 
not coagulate, a black sediment, upon which is formed clear scrum. 

3d. The blood of the vena porta contains on an average, when fresh, 5.23 
per cent., and when dry, 0.74 per cent, less iibrine than the blood of the ar- 
teries and the other veins. 

4th. The liquid blood of the vena porta contains generally a little less 
solid matter (O.ld to 0.3 per cent.) than the arterial blood and the other ve- 
blpod. 

6th. Its serum contains generally 1.58 less solid matter than the arterial 
Brum, and 0.80 less than that of other venous blood, [n the dry slate, the 
first is of an ash-gray, the second yellow, the third greenish-yellow. 

0th. The blood of the vena porta contains proportionably more oruor* ami 

less albumen ; the contrary is the case m the arterial blood : the dry cruor 

of the vena porta is browinsh gray, that of the Other veins deep red, that 

,.i the arteries bright red. 

7th. The blood of the vena porta contains in its solid parts almost twice 

as much fat as that of the arteries and the ether veins. The proportion is as 

follows : — 

Blood of the vena porta, - - 1.06 per cent. 
Arterial blood, - 0.92 « 

Venous blood of the other veins, - 0.83 rt 



1830. J Hydrocele of the Ace/.-. 47 

8th. The dry serum of the vena porta contains but 0/i7 per cent. 

tan the dry serum ofth fchfi other veins. 

9th. rhe albuminous cruorof the vena porta - 1. 11 pei 

•,•1 rre fat thanthatoftbe arterial Wood, and L.21 pi rem:, mora than I 
the blood of the other \ ■•■. . 

10th. It is in the fibrin that this difference is th 1 • yfibrin 

vend, porta contains 10.70 percent, of fat ; thai of the arteries 2.8-1 p< r 

. so that "he diffi at. 

llth. The fet efthe blood offche vena porta is blackisji brown and imctu- 

,,:i.- ; thafcoi Lrl M-i-.l blood and other venous blood white, or yellowish-wiute 

if the white chyle to two^thirds liquid and one-third 

■ 



Hydrocele, of the Neclc. 

Ever since its existence was first declared, this di.sea.sr 
been generally unnoticed. by practitioners and by teachers. We 
are pleased with an opportunity of re-publishing the notice of it 
contained in the last No. of the American Journal, from James 
O'Beirne, M. D. alike on account of the great importance. of its 
diagnosis and treatment, and of the opportunity afforded of ex- 
p ising the injurious influences extended to the cause of humanity 
by the anathema of high authority. Those who arc full fledged 
with the brilliant plumage of fame, or whose vanity causes them 
to think themselves so, arc often wont to proscribe, in the most 
pointed and dogmatical manner, the opinions and facts of those 
who have not been so. puffed abroad as themselves. Thus it 
has been with the valuable manuscript memoir' of Professor 
Maunoir, of Geneva, on the disease to which he gave the name 
of Hydrocele of the neck, and which, though essentially different. 
in its nature, and requiring a very different mode of treatment. 
has such a resemblance to Bronchocele, or goitre, that it has 
been constantly confounded with the latter disease, and treated 
accordingly. This valuable memoir was read to the Royal In- 
stitute of France in 1815, and. as we are informed, subsequently 
transferred to the Academy of Natural Sciences, by which body 
the late celebrated Baron Percy was selected to report on its 
merits. It was not, however, until April, 1817, that the Baron 
presented his report, which proved highly unfavourable to Pro- 
fessor Maunoir's opinions and practice. With the burthen of 
this proscription, Professor M. did not rise to the publication of 
his memoir for seven whole years ; at the end of which time he 
did for the first time publish it, with the whole of the unfavour- 
able report made thereon, nnd a most able and satisfactory de- 



18 of the N* [7un e ' 

juliar views on the subject. T3.it, (continues 
O'Bi Lrne) it would appear that, as too often happens, the autho- 
rity 1 pf a greal same, aided by bold and specious objecti 
proved more powerful than either the strongest i". 

:is. as proven by the fact that nothing has been said about it 
; 'i Prance or England; and, even Delpech of the former, and 
Lawrence of the hitter, have reported cases of this ven 
which they have treated by incision, without making tin ! ^ast 
allusion to the less dangerous and disfiguring treatment so 
cessfully adopted by Professor M. 

Since he was ac fidentally possessed of the essay " sur FTIy- 
••le du eou," O'Beirne lias been favoured with three stri 
examples of the d all of which displayed the utter fall 

of Baron Percy's objections, and which he proceeds to give. 
follows : 

Di<zg7Ws£s.^Accordii^toProfes8dr Maunoir, the disease has been often ob- 
served withoul its true nature homo; known; as may be seen in treatises on 
urs, and from one detailed by TIcis f er, and .three cases ''.noted bv Plou- 
ciuet. He declares also, that all the cases of it which he b's seeD, had 
been confounded with and treated as goitre, by numerous members of the 
profession. The disease eonsists in the formation of serous cysts, commen- 
cing very small at some point of the side of the neck, and gradually increasing 
vcral years, to such a size as to occupy the whole, of the front and of one 
side, of the neck, and seriously to impede respiration, deglutition and speech. 

The tumour so formed conveys to the touch a distinct sense o fhu tu i- 
tion, and contains a fluid of either a limpish, a reddish? or a dark coffee 
colour, and coagulable by lieat. In the great majority' of instances, ; * exists 
independently o'f'any enlargement of the thyroid gland: and in bis fourth 

. it was situated behind the an^le of the lower jaw, and of course, > 
removed from this gland. But he lias, in two instances, observed the con- 
trary; and the second of bis cases, in which the gland enlarged and indurated 
formed one-eighth of the whole tumour, is an example of this complication. 

Treatment. — With respect to the treatment of this/ disease, the learned 
Professor's opinions and practice are these : "Although," he says, "there may 
be great affinity between encysted tumours in the neck, and hydroc le i 
tunica v iginalis, yet it appears to me that, in hydrocele of the neck, the cyst 
is more dense, and morcdifficultto.be excited to aabesive inflammal 
Accordingly its treatment should not be directed by analogy, and it is i ot 
proper to have recourse to the euro by injection, although it seems, at a first 
view, to be the best. I wished to try it, and have been obliged to renoi 
it as a bad plan, and not one free from danger. An injection, which is not 

. stimulating, will effect nothing, or almost nothing, on a very thick, and 
m general, an old cyst. If a very active inj< ctfon be employed, it wilKcause 
greal pain, andgive rise-to very alarming spasmodic symptoms. Moreover 
I have to observe, thai Bometimes enlargement of the thyroid gland compli- 
cates the treatment. In that case, the object is not merely to produ< e a l- 
hesion of the walls of the sac ; i f will be necessary to employ a mode of cure 
by which we may succeed al the same time in resolving this glaj d, w ben it 
projects 'into the tumour, as 1 have soon in two patients." A- to I ying 
open the tumour bv incisions, as practised by Heister, or extirpation of the 

■'- orofoidv a part ol the cyst, he condi inns these op< rations as being 
serioi I calculated to prolong producing a large 

•■ oiii! d, and one of a kind very slow in cicatrizing. In short, the treatment 



1830.] Hydrocele of the Neck. 49 

which. he lias been led to adopt and recommend consists in puncturing the 
tumour, an<!, after e\ acuating fta contents, passing a seton through it in tho 

direction of its longest diameter. By this plan a fresh accumulation of fluid 
is prevented, the adhesion of the walls of the cyst, is insured, and the thy- 
roid gland when it happens to be enlarged, is gradually reduced to its 
natural size. 

!l • relates three cases, all of which are so generally interesting, that I 
Bhall her6 give them in a comparatively abridged form. 

i. — A washer-woman named .Martin, aged 49, still menstruating, 
with a spherical tumour on the front and left side of the neck, as large as 
an infant's head, presented the first example of the disease that the Pro- 
>i had seep, read, or heard of. Originally this tumour had been very 
small, but increased in quite an insensible manner. It did not force the 
head to incline to the left, but to the right side, and formed a sort of cush- 
ion for her head to rest upon. She had taken burnt sponge, and many 
other boasted remedies for .goitre, but without any benefit. Difficulty of 
breathing and swallowing came on, and increased in proportion to the 
growth of the tumour. One day, while washing at the river side, she 
threw up a very great quantity of blood, fainted, and was supposed for some 
moments to be dead. The haemoptysis and oppression continuing, and the 
swelling being felt to contain a fluid, a trochar was passed into the most 
prominent and fluctuating part of the tumour, and gave exit to a pint and a 
half of a deep brown liquid, which coagulated by the application of heat. 
Complete relief ensued. On the following day, the swelling had returned 
to its former size, but fluctuation was less manifest, for infiltration had taken 
place between the tumour and the skin. 

At the end of fifteen days this infiltration had disappeared, and Vie cyst 
was punctured by a trochar, and after being emptied, filled with warm red 
wine and a small portion of alcohol. This injection, although retamed but 
for a few moments, caused great pain and suffering. Swelling, redness, 
trismus, and increasing pain, on the following day : leeches, poultices, ape- 
rient medicines, and opium, ordered. -An abscess, external to the cyst, 
opened and treated in the ordinary way, untd it healed. A third puncture 
made in the upper part of the cyst by a sharp-pointed bistoury, and giving 
exit to as considerable a quantity of fluid as at the second. A button- 
pointed probe was then introduced into the -opening, and passed until it be- 
came prominent at the most inferior part of the tumour ; the point of the 
probe then cut upon, and the instrument withdrawn, leaving in its place a 
single thread. This thread frequently renevyed : no accumulation of fluid. 
A seton of ravelled linen passed, and caused abundant suppuration. This 
seton continued for six weeks, and then removed by the patient, on account 
of interfering with her ordinary occupations. Both openings iistulous for 
some months ; the upper first closed ; and in the year 1813, when she was 
G3 years of age, her neck was very slender, and her health robust. 

Case II. — Monsieur C, of Vevay, aged 40, had for many yeais a tumour 
situated on the front and right side of the neck. This tumour extended 
from the chin and lower jaw to the sternum and clavicle : and in the greater 
part of its extent, there was a manifest sense of fluctuation, but points 
corresponding to the thyroid gland appeared to be hard and prominent. 
The swelling increased daily, became fatiguing from its weight, and ulti- 
mately caused difficulty of respiration and speech, and occasionally attacks 
m which he seemed to be on the point of expiring. A puncture made into 
the upper and left portion of the tunlour, and a pint of limpid, amber-co- 
loured, and perfectly inodorous fluid evacuated. This evacuation reduced 
the tumour to one-eighth of its size, the remaining portion being formed by 
the thyroid gland in an enlarged and indurated state. A blunt probe now 
Introduced into the opening in the sac, and carried down to the inferior and 
anterior portions of the tumour; the point of the probe cut upon, and a sin- 
gle thread passed, in the usual way, as a seton. Great freedom of rc-sni, 
• 7 



tfO Hydrocele of the Netk. [June- 

ration and in moving: the head, instantly followed the complete evacua 
of the tumour. Next day, a fresh accumulation of fluid, but much let 
quantity, and of a fetid, Banious kind; some fever; stomach deran. 
Hyppo," followed by infusion of bark, and Spa and Seltzer Waters emplo 
and restored the patient to Ins ordinary cairn state. Pieces of line;] gr 
ally increased in size, and smeared with simple digestive ointment, introdu- 
ced as setons ; injections of plain and hydrcsulpkurated water, and decoc- 
tion of bark, with honey thrown into the sac. 

Discharge less in quantity, and more purulent : the extent of the cavity 
greatly contracted ; and the thyroid gland diminished in size. In a f. v. 
months the patient's health was completely restored, ana his neck became- 
of its natural size. 

Case III. — Mademoiselle T. D. aged 20, having for many years a large 
tumour on the front, and a little to the right side of the neck, had been 
subjected to all the known modes of treating goitre. This tumour was of 
enormous size, and consisted in a great degree of fluid. The least move- 
ment brought on cough, and attacks of suffocation. Her parents and friends 
refused to permit a seton to be passed, but a puncture with a trochar was 
made in the most depending part, and a cupful 6f fluid, resembling infusion 
of coffee, was drawn off. The canula was then withdrawn, with a view of 
retaining the rest of the fluid, and enabling a second puncture to be made 
and a scton to be passed. The tumour was very little diminished ; the 
wound was then covered with adhesive plaster, and a roller applied with 
moderate firmness. After passing some hours in a very quiet state, she 
indulged too freely at dinner, and in the evening felt oppressed in her breath- 
ing, and the tumour became quite black. It was evident, in fact, that the 
contents of the sac had passed into the subcutaneous cellular membrane. 
She passed the night badly, and could scarcely swallow a few drops of an 
anodyne draught. In the morning great difficulty of respiration, and total 
incapability of swallowing; the part? surrounding "the tumour so swelled that 
the neck was raised to the level of the chin and lower jaw, with which if 
seemed to form one continued pillar. The. whole of the upper part of the 
thorax was also infiltrated, and the alteration of the voice and dyspnoea 
were such as to lead to the belief that the effervesced- fluid had penetrated 
into the internal cellular tissue of the trachea.- In the course of the di \. 
however, all these symptoms gradually diminished in severity, and the 
swelling was considerably reduecd towards evening. She passed a good 
night, and on the following morning deglutition and respiration were free. 
On the fourth day from the operation, the original tumour was diminisl d 
by one half, the infiltration and black colour of the skin had disappeared, 
and the patient was in excellent health. 

On the 90th of January, 1812, that is, after about six weeks had elapsed, 
the tumour was as large and as distressing as ever. A hydrocele trochar. 
with a flat elastic canula, was passed into its most depending part, and two 
pints of a dark brown fluid, coagulable by heat, wit. 1 oil charged. On 
emptying the tumour, the thyroid gland was found moderately enlarged. A 
blunt probe, armed With a single thread, introduced through the canula, 
made prominent at the upper part of the cyst, and there cut upon uu' 
could be withdrawn, and the thread left as a seton. For some days nervous 
symptoms appeared. The two little incisions contracted so much, that the 
thread could not be moved backwards and forwards but wilhgreat difficulty, 
and such as to create a suspicion of its being lodged in the tissues of the 
walls of the cvst, which it had cut in gliding, and of haying thus lefl the 
cavity of the tumour. The silk thread withdrawn, at the instance of her 
parents, and in order thai a fresh accumulation might perrail a puncti r a 
be made by a bistoury, (instead of the trochar which had been found bo i!J- 
siuted,) and enable a COtton wick to he passed as a seton. The tumour 

soon regained In former size, and the oppression returned. The necessity 
Qf this operation repeatedly urged, but as often delayed from some frivolous 



IS3G. ] Hydrocele, of tht Neck. g 

■xt. The Professor sent for in great liaste, on the 16th of April, 1812. 
and found her with complete loss of sense and motion, slow and stertorious 
breathing, cold extremities, dilated pupils, and no pulse. iNo person being at 
hand to aesisl in the proposed operation, the tumour was punctured by a 
hydrocele trochar, and a pint of dark brown fluid discharged: Immediately 
pulse, respiration, and in short, animation were restored ; but permission to 
- a seton could net be obtained. On the 7th of May, the size of the' tu- 
mour required that it should be again punctured. On the 24th of June, she 
complained of violent pains in the head, great suffering and oppression. 
Another puncture made in the swelling, and a quantity of fluid mixed, with 
purulent matter, discharged. 25th, pains returned ; astringent applications; 
increased enlargement of the neck ; distress and oppression alarming. Six 
leeches applied, and the patient well purged. with castor oil, without any 
relief. 27th, tumour punctured, and a less quantity of fluid, but more mix- 
ed with pros, discharged. 21st of July, symptoms severe, and increasing so 
much in violence, as to require another puncture, which was rendered diffi- 
cult by the thickness which the infiltrated cellular membrane had acquired, 
ami, consequently the increased depth at which the cyst was placed. A 

-hread. and, subsequently, a large seton inserted; abundant fetid sup- 
puration ; gradual contraction of the sac ; an abscess formed and opened at 
the inferior and laternal part of the neck ; a fistulous opening for some 
months at this point, and at length healed by an injection of a weak solution 
of sulphate of copper. Seton removed ; tumour completely dispersed ; and 
recovery perfcci in all respects. — Dublin Journal of Medical and Chemical' 



5^ On Caiicrr. [June 



Past, hi.— monthly periscope. 

Cancer. — Professor Benedict states that during a certain pe- 
riod, the operation for cancer (not including cancer of the lip,) 
was performed at the Clinique thirty-seven times ; and that, 
with the exception of one or two cases treated by arsenic, a 
radical cure was not obtained in a single case. 

Extirpation of the breast was performed three times, and un- 
der circumstances apparently very favourable; in all of which 
the disease returned again. Of ninety-eight amputations of the 
breast, which he has performed since he undertook the charge 
of the Clinique, two ended fatally, from exhaustion during the 
healing of the wound; and in all the rest, with the exception of 
thirteen, the disease returned after the wound was healed, and 
terminated in death. With regard to the remaining thirteen, 
he observes he is morally convinced that, in several cases, an 
error in diagnosis was committed, and breasts were removed 
that were 'merely affected with scrofulous tumours, sarcoma, or 
some other innocent change of structure. 

On this statement, the editor of the Lancet observes : " The 
above results are worthy of serious attention, and serve, unfor- 
tunately, to confirm the opinion advanced by many surgeons. 
that in most cases cancer is a constitutional, not a local dis- 
ease." Amer. Jour. Feb. 183G, p. 513. 

We give the above extract, not by way of recommending the 
intelligence it contains, but of staying, if possible, its injurious 
tendencies. We had thought that it was plain to all surgeons 
by this time, that there were two grand errors in the practice 
of surgery in this disease ; 1st. A want of early diagnosis. 
2d. 1 rocrastination of the operation to too late a period — the 
latter arising sometimes from the former ; but most commonly 
from t v e patient's objections to the operation, or the surgeon 
having been called in too advanced a stage or the disease. 

Our experience in the treatment of this disease has certainly 
not been great ; but still, small as it may have been, it leaves us 
in far better hope of benefit from the knife than the above state- 
ment would seem to justify, We have not kept a record of 
ca^rs, but will give the last four. Of these, two cases, as well 
characterized for the state of their advancement as those which 
ordinarily bid defiance to the knife, wen; amputated. The 
wounds healed kindly by adhesion, without any exhausting dis- 
charge or irritation. The Women remained well. In the third, 
the well marked scirrhus was so small and distinct that we could 
not. resist the temptation to extirpate ii : a practice so long and 
so justly condemned by the most judicious. This was done, 
with the removal of a considerable portion of the adjoining sub- 



IS.'**;.] On Cm 



stance, making in all three to four oz. in weight"; an3 a 
Btance whose whole diameter was not less than double that of 
the scirrhus. The wound healed within few days. A few 
months alter, however, the disease returned in the same place 
With rapidly exasperating symptoms. A distinct scirrhus tume- 
faction soon presented itself, larger than the whole substance 
before extirpated : manifi sting the extension of its influence to- 
wards that part of the breast nearest the axilla. Entire ampu- 
tation of the whole glandular portion of the breast, with all the 
adipose substance before the pectoral muscles, was now adopted 
— the incision extending to the glands and lymphatics between 
the mammre and the axilla, whereby these were removed. 
This wound was found well on removing the dressing on the 
tilth day, and the patient has to this day, (now thirteen years,) 
had no return &f symptoms. The fourth case was one in an old 
lady, who had been watching its progress for ten or eleven 
years. Its developement, although it had been slow, had now 
arrived so near the state of ulceration that the nipple and a lit- 
tle of the adjoining part dropped off during the operation. It 
was, how r ever, amputated very entirely, and the wound dressed 
for adhesion. A consecutive haemorrhage coming on, caused 
the wound to be re-opened for staunching the haemorrhage. 
This delaved the cure to about the thirteenth day, by which time 
it was so w r ell that she was discharged to go home, about ninety 
miles. About six or eight months after this operation, I recei- 
ved a letter from the husband of the patient, stating that her 
health was every way greatly improved — that there had been 
no threatenings of return of the disease, but that she had been 
extremely well, had thriven finely, and that, in short, her health 
was every' way better than it had been in twelve years. Be- 
fore two years had elapsed, however, this patient's health be- 
came impaired, manifesting, as her attendants said, a general 
cancerous diathesis, of which she died after some months. 

This experience, we say, leaves us in better hopes from sur- 
gery in these cases. And we are compelled to believe that 
there has been something, nay, much of the common errors to 
wdiich we have before alluded, in the practice, the ill success of 
which has been given us by Professor Benedict. 

We are not of those who are willing to allow an English or 
a Continental surgeon to doom a practice, because he may have 
been unfortunate in not making early diagnosis, or in not per- 
forming his operations with that science and thoroughness he 
should have done. And more especially are we so, when we 
know of very many practitioners throughout our Southern 
country, and freely venture the opinion that there arc many 
hundreds in these l T nitcd States, whose practice, if faithfully 
detailed, will prove these points : that the amputation of the 
cancerous breast, (not the extirpation of the scirrhus tumour,) 



N Morbid Adhesion of the Placenta. [June. 

will, if performed before a certain advanced and extended stage 
of the disease, generally, if not always, prove finally curative; 
and that when advanced to, or near the ulcerated state, espe- 
cially if its progress has been slow, and after the close of men- 
struation, the oi^ease will very generally return in the same, or 
some other part; or a general impairment of health supervene, 
l'or which the science affords no hope. 

We are aware that there have been, and still are many 
breast cullers, who occasionally find glorious opportunities of 
mounting surgical stilts by cutting off and curing as cancerous, 
a breast which has suffered a contusion by corsets, or a tedious 
obstruction of the milk tubes. 

Some such cases we have had the ill fortune to oppose in 
consultation, but too often unsuccessfully. These misfortunes 
are, however, the faults of ignorance or empiricism, and not of 
science. We have long been of opinion that in several of the 
important points of surgery, as well as practice, there is in the 
United States at least a practical superiority over the transat- 
lantic. We know this to be the fact in some places in the South 
as well as North. And we should be pleased to sec the results 
of Dr. Physic's practice on the point under consideration laid 
beside the practice at the Clinique. 



Morbid Adhesion of the Placenta.' — In the American Jour* 
nal for Feb. 1830, we find a case of morbid adhesion of the pla- 
centa, as reported in the London Medical Quarter! v Review for 
July, by Dr. Litchfield. 

Mary Farrell, set. 32, was attended m her first confinement in 
March, 1835. by Mr. Barry, of Brunswick Square. Labour 
lingering — pains light, and after long intervals. Sixteen hours 
after the commencement of labour, the accoucheur administered 
half a dracm of powdered Ergot, and repeated the dose every 
two hours. At the expiration of twenty-four hours, a dead child 
was expelled, and the uterus contracted forcibly around the 
placenta, so as to baffle the frequent attempts of the accoucheur 
to remove it. Eighteen hours after delivery, Dr. Litchfield 
saw her in consultation. The uterus was found high up beneath 
the abdominal parietes, and contracted at its fundus into a hard, 
irregular tumour. The external parts were swollen and pain- 
ful, arid the os uteri so rigid and unyielding as to resist the perse- 
vering efforts of the hand to dilate it. Pulse full, hard, and 95. 
Tongue furred and feverish : the face flushed, and severe pain in 
the head. 

Depletion, and small, repeated doses of tartarized antimony, 
with fomentations of flannel to the pudendum, were prescribed. 
Under this treatment the violence of the symptoms subsided, and 



I830.J Morbid Adhesion of the Placenta. ."."> 

fresh, long continued, but unsuccessful attempts we 
made to dilate the os uteri, and deliver the placenta: Bein 
opinion that it would be impossible in the present state of the 
parts to reach and overcome the adhesion, and having no fear of 
immediate haemorrhage, it was resolved to wait, and watch 
closely both the local and constitutional symptoms, abstain 
for the present from farther manual interference. 

Thus continued the case, the patient remaining in a wry satis- 
factory state, until the fourth day, when the discharge, which had 
set in as usual, became very copious, offensive, and of a greenish 
colour. Chloride of soda was used for the correction of the 
offensive odour, and the patient went on without unfavourable 
symptoms till the eighth day, when a portion of the placenta, 
equal to 1-3 of its usual weight, was thrown off in a putrid state. 
From this time, small portions continued to oe detached at in- 
tervals, until the twenty-first day, by which time all the placen- 
tal structure was thrown off. 

The progress of the case was unattended with pain or Iue- 
morrhag;* ; the patient improved rapidly, during the time, in 

its, strength, and appetite ; and at the end of one month 
from delivery, menstruated in a regular way. Strong ligamen- 
to is bands were found in the placental mass. 

We consider this case as one of no trivial -importance. And 
whilst we regard it as a faithful relation of lacts, we feel it a 
duty to guard young practitioners, (and we may say some old 
ones too,) against the danger of adopting a practice already too 
common, and to the increase of which this case is calculated to 
contribute — we mean that of leaving placental delivery to na- 
ture, from an undue confidence, not only in the efficiency, of un- 
assisted nature, but in the safety to the mother with which the 
placenta may be allowed to remain and putrify within the uterus. 

It should be remembered, that a putrid foetus seldom fails to 
manifest by various symptoms its deleterious effects on the vi- 
tal energies of the mother ; and that the injurious influence of 
the putrid placenta is still more manifest and certain. 

It should be borne in mind also, that the decision of the con- 
sultation in this case, of leaving to nature the final deliverance, 
was not, by any means a matter of election ; but was really the 
absolute and unavoidable necessity of the case. It was done, 
and prudently too, because there could be no alternative but 
what would be fraught with still greater danger. The case 
truly resulted most happily. To adopt this plan however, in 
our practice, whilst it might suit the partial theorisings of the 
expectant practitioner, so well calculated to let patients die, 
would, we apprehend comport but ill with the duties and ob- 
ligations of the truly rational, which rank much higher than 
mere passive expectation. These surely demand not only a 
knowledge of the structure and functional arrangements • ''the 



Morbid A i of the Placenta. [June, 

animal organization and the vital energies, both physiologica \ 
and pathologically considered; but also of the powers oj the 
various resources, whether medical, instrumental, or manual, 
which are at his command for assisting inefficient nature in Lh i 
removal of noxious causes, and the correction of their effects. 
To fold one's arms then, and rest in confidence, that unassis i d 
nature will accomplish every good, would be, in main of these 

es, but to leave the patient to die. Whilst, therefore 
practitioner is bound not to administer mortal powers, he is no 
less bound not to withliold anything which may contribute to the 
well being of the patient : for there is little difference to the in- 
terest and feelings of his employers, whether he kills, or allows 
death to supervene for want of those administrations, which 
were at his command. It is not enough for the practitioners to 
have done what he chanced to think best by his partial reason- 
ings, and speculative views- — he is bound to do ad that die sci- 
ence of medicine can afford for the welfare of his patient. 

Whilst therefore, we acknowledge most candidly our great 
obligation to Dr. Litchfield, for having reported the case, and 
express our desire,, that all similar cases may be made public, 
still we would only look on them as messengers of hope from 
afar, which may serve to cheer us when we arc brought to bow 
under our impotence, and humiliation, and witness the final 
failure of our physical resources : and as calculated to shed a 
ray of hope and comfort on her wdio is otherwise overwhelmed 
with weakness, misery and despair. 

It is stated that during the latter months of pregnancy, the 
patient suffered fixed pains in the womb, arising, as she suppose d, 
from a blow on the abdomen. It seemed probable to Dr. Litch- 
field, that under these circumstances, the vessels of the uterus, 
being stimulated to undue action, had thrown out coagulated 
lymph, whereby fchc placental and uterine surfaces had become 
morbidly united. 

We believe Dr. Litchfield accounts correctly for the undue 
attachment of the placenta: and are able to give a case of very 
recent occurrence in corroboration, so far as relates to this 
pathological point; 

Lasl February we had the management of a case of very 
protracted premature labour. The presentation when made, 
was abdominal. Turning was of course effected as soon as 
the band could be passed, and an eight month child delivered. 
( )n finding the placenta not detached, the patient being much 
fatigued and having no pains after delivery, was allowed to 

about two hoars. 

I't. rine contractions were then promoted by friction with the 
hand, but no separation was effected. Alter occasional efforts, 
for several hours, in the ordinary ways for deliverance, without 
any encouragement, the hand was passed to the placenta, which 



IQ'A Raid's Independent Spring Trt&s. f// 

ild not then be detached in less than two hours, v.iih all the 
effort pruden • would affow. On inspection when delivered, a 
rable portion of the uterine face of the placenta present- 
ed an unusually d< rise, ev .1 and whitish appearance, which in- 
duced me to believe that adhesive mnammation had existed. 
This woman had, by a ride on the rail-rosR to Charleston, or 
so, ne accid nt attending the trip, brought oua flooding, which, 
though very considerable, and causing some days illness, was 
not followed by abortion, hhe recovered, and returned home ; 
after which she was occasionally troubled with irritations of the 
uterus, from depression, which continued to increase until the 
gravid uterus was placed high in the abdomen, and the patient 
confined to bed for several days. In one instance, free vene- 
section at the arm was necessary, on account of the inflamma- 
tion of the uterus from this cause. Indeed the present prema- 
ture delivery was brought 011 by a neglected return of the same 
circumstances. 

Do not these facts afford ground to suspect at least, that the 
circumstance of adherent placenta is generally attributable to 
inflammatory action some way produced ? And should it not 
serve to direct the attention of the practitioner more particularly 
to that state so often produced in the posterior region of the 
uterus by even slight degrees of prolapsus in pregnancy ? 



Reid's Independent Spring Truss. — This is a truss invented 
by our townsman, Rev. Henry Reid, and is truly what its name 
imports — an independent spring truss. It needs neither buckle, 
button nor strap for its accurate and effectual retention in place. 
It is retained solely by a spring power, and is alike applicable 
to Hernia) on either or each side, by having a block at one end 
and a cushion at the other ; or a block at both. A block simi- 
lar to Stagner's is adopted, but altered to suit the peculiarities 
of cases. The pressure is made by a well tempered spring, 
which passes from one groin, behind the pelvis and to the oppo- 
site side — the metal being left untempered near the block, in 
order to make, by binding it at pleasure, any little change in its 
direction which the case may require. The whole metallic part 
is covered with a strip of flannel, and is so shaped as to lie in 
contact with the skin, making no sensible pressure but on the 
hernial openings. We have witnessed its application in a va- 
riety of cases, and are pleased with its neatness, simplicity, and 
efficacy in the power of retention; and we have no reason to 
doubt but that, whatever curative powers may attach to Stag- 
ner's or Chase's blocks, will also be found with this. It has an 
advantage over all other trusses in this, that as it needs no strap* 

' I lull's has no strap, but has not the power of relcnUwH. 

8 



58 Dr. Praifs improved .Nipple Shield. [June. 

to pass before the abdomen, it will be applicable to women in 
parturition. This truss was subjected to the inspection of the 
.Medical Society of this place, at a late session, and was referred 
to a committee for testing its powers and reporting on it. 
That committee reported iheir application of the ins'rument to 
seven cases, in all of which its efficacy, neatness and conve- 
nience were well demonstrated. 



Dr. PratCs improved Nipple Shield. — We have recently had 
the pleasure of witnessing the effectual use of Dr. Pratt's latest 
improvement of this valuable article; and have been delighted 
with the ease and efficacy attending its application. Although 
it would seem a trivial tiling, hcin^ nothing but a small metallic 
cup, with the nipple of the heifer attached, still, when we reflect 
on the great sufferings and injuries we have often witnessed in 
consequence of the want of just such an article, we cannot bul 
feci the greatest satisfaction in being able to recommend it most 
freely to the notice of all those whose Office it is to prevent nnd 
alleviate the sufferings of those for whose benefit it is intended. 
However simple the instrument may appear on superficial ob- 
servation, slill it is just what it should be. The metallic cup is 
so constructed as to adhere well r and at the same time, prevent 
t' at drawing of the substance of the breast into it, as to obstruct 
the milk ducts ; and the nipplo is so finely tanned and prepared 
as not only to possess all the softness of velvet, or* of the best 
buckskin, but is so well dissected and prepared as to be ca- 
pable of being inverted for cleansing, and of collapsing so 
effectually on suction, as to retain its place on the breast with- 
out being held by the hand: We give below the report of the 
Committee of the Medical Society of Augusta, to whom it was 
referred. 

"The committee to whom Dr. Pratt's improved nipple shk Id 
w T as referred, take great pleasure in reporting, that they have 
h( en able to demonstrate, in the most satisfactory manner, tin- 
very complete adaptation of that instrument to its intended pur- 

Your committee have been so fortunate as to sec its applica- 
tion to a breasl in which, from great previous inflammation, the 
milk vessels about the nipple were contracted, and consequently 
always disposing to serious obstructions. All other means of 
drawing the breast had been repeatedly used in the ease, with 
n<> fetter effects than these <.f drawing so much of the breast 
into the Opening of the instrument as entirely to obstruct, the 
passage of milk ; and affording pain in various degrees. The 
peculiar shape of tic m< Gallic portion of Dr. rratfs instrument 
completely prevented both these difficulties; and at the same 



L83&.J Mr. flfiddlemore's Repbrt. ;o 

time, with all practical force in drawing, presented the lender 
nipple from touching the metallic cap withitt. The valuable 
quality of remaining adherent with) Lit being held on by the 
hand, or when the suction was discontinued, was also fully de- 
monstrated. 

In conclusion, your committee arc truly happy in feeling as- 
red that in the instrument invented by Dr. Pratt, the commu- 
nity is presented with the means of both obviating, and removing 
when present, all that incalculable sum of misery which women 
have been accustomed to bear for a length of time, in conse- 
quence of sore nipples ; and even of preserving the lives of many 
infants. Who, in consequence of diseased breasts, and the want 
of nipples, are turned over to hand-nursing — a prolific source of 
disease and death; for this instrument supplies the place of the 
'natural nipple most admirably and perfectly." 



Mr. Middlemore, in his annual report of the Birmingham In- 
'firm, ry for diseases of the eye, which we find in the Medico- 
Cnirurgical Review for July, briefly describes his usual plan of 
operating on children from one to three years old, for complete 

i sjineta] cataract. He fully dilates the pupil by the use of a 
strong solution of hyosciamus. The child's body is securely 
enveloped in a napkin, with the arms fixed to the sides. The 
child is placed upon a table of convenient height, with the head 
slightly raiseo". The head is firmly fixed by an assistant press- 
in •• his hands on either side of it. If the right eye, he raises the 
upper eyelid, and fixes the ball by pressing the index finger 
upon the temporal, and the middle finger upon the nasal side of 
it. Thus prepared, he rapidly passes a very fine needle through 
the cornea, near its junction with the schlcrotica, and simply la- 
cerates the capsule by slightly moving its point a little back- 
Is, and to either side. 

He directs the needle to be very fine and slender, sharp at 
the point, a little flattened towards the point, having a cutting 
edge on either side for a short distance from the point ; and gra- 
dually becoming round towards the handle. 

Mr. ■ M. gives the following very rational description of this 
mode of operating : 

" The advantages of this mode of operating, arc neither few 
nor unimportant. 

In the first place, it is quite efficacious, and quite competent 
to the removal of the disease, or, at least, only requires to be 
performed a second time ; secondly, when properly performed, 
: it involves no risk of injuring any important texture, except the 
cornea ; thirdly, it gives r'se to scarcely any pain ; and fourthly, 
it excites hardly an appreciable amount of inflammation." 



09 Carcinoma of the Tongue. [Jkinc, 

Having always had a great aversion to wounding the cornea, 
wc have never operated through it, either for extracting, cr 
causing absorption. But we have some reason b I r. M s. 

experience, to believe in the superior claims of this particular 
operation. In two or three oi' our last cases we have been 
greatly perplexed with the severe and ungovernable inflamma- 
tion which has superceded en redinatien b\ Scarpa's needle in 
the common way, notwithstanding the inclination was easily 
and effectually done, and the power of very distinct vision pro- 
ved immediately after the operation. J hese operations were 
effected with but Very inconsiderable pain. The subjects were 
all old, but were as carefully prepared lor avoiding inflammation 
as possible. The pupils in these cases were all dilated by the use 
oi Belladonna, the long application of which was necessary to ef- 
feel the purpose. The inflammation, however, in all of them, ran 
high : and in one^asc, particularly, in which the ope ration appear- 
ed to have succeeded very finely, and the patient had been pre- 
pared under our own immediate attention, with great care, so 
extreme was the inflammation for more than a month, thai when 
it did subside, the power of vision was entirely destroyed ; aor 
has it improved in the least, — now ten months since the operation. 

The pupil is perfectly clear, and the iris retains its natural 
susceptibilities. Perhaps, too, the Hyosciamus may be a more 
safe dilating power than the Belladonna* 

In the same report, ?>Ir. Middlemorc earnestly entreats his 
brethren to test the effects of Strychnia in Amourosis. With 
those effects he is amply satisfied, and is a warm advocate of 
(he value of this remedy. Yet he thinks it has been employed 
in an indiscriminate manner, andhe feels convinced that all who 
employ it with judgment and care, will form the same conclu- 
sions of its qualities as he has done. — Medical Cliintrgical /?«- 
\ for July, 1836, p. 254. 



Carcinoma of the Tortgue, successfully treated with the Liga- 
ture. — In the American Intelligence contained in the American 
Journal for February, we have an account of a case reported by 
Dr. Donnellan, of Donaldsonville, Louisiana, of a large, ragged, 
ill-conditioned ulcer of the tongue, \\ hich, :; • >m its presenl charac- 
ter and the history of the ease, he considered cancerous ; cured by 
the ligature, as recommended and practiced by Sir Edward 
Home, The ulcer occupied the righl anterior partofthe tongue 
to a <•< • extent, and was progressing very rapidly. 

T*he subject w\ is very corpalenl woman, 25 years of age, and 
m the 8th month of pregnancy; "when lie first saw hef: at which 
4 ;tiic there was but a sued! ulcer on the party apparently of no 
importance. On the 23d day alter, on being called to the case, 



1 89&J Gfoitre—Cure of by e i Hrpation. < : I 

he found that the ulcer had made such fearful | . thai he 

deemed it proper tO t operate, and risk its effects on her preg 
in preference to allowing the ravages of the ^disease, even for the 
short remnant of the gestation period. 

A crooked needle armed with a strong ligature was passed 
through the middle of the tongue* behind the ulcer. The liga- 
ture was then cut at the needle, and one tightly drawn and. tied 
en each side of the ulcer 5 thus cutting off the circulation from 
the diseased portion which constituted a considerable sigment of 
the right side and tip of the organ. The pain on tightening the 
ligatures was very intense, which was soon relieved bv 00 drops 
ofTr.Opii. 

A few hours after the operation, a copious salivation super- 
vened, which continued till the dropping off of the diseased part. 
Five days after the operation — 29th April, deep sloughs were 
produced by the ligatures. On the 4th May, ten days after the 
operation, a single ligature was applied in the fissures caused by 
the old ones, so as to embrace the whole, which dropped off on 
the 6th — twelve days after the operation. On the 11th May, 
the vacuity was found fast filling up with granulations, and .on 
the 23d, was perfectly cicatrized — the patient havinggiven birth, 
some eight or ten days previous, to a fine healthy child. Her 
articulation was but slightly impaired, and at the last observation 
she continued in excellent health. 



Goitre — cure of by extirpation. — Two cases of this disease 
have been cured by Professor Graeefe, of Berlin, [n the first 
case given, the tumour was of the -size of a goose's e^g, in the 
middle and anterior part of the neck, which caused extreme dif- 
ficulty in deglutition and respiration. These symptoms assured 
the Professor that the tumour adhered closely to the larynx and 
trachea, which fact he bore in mind during the operation. An 
incision was made through the skin, commencing a finger's 
breadth above the superior margin of the thyroid cartilage, 
and extending down the median line, to the top of the eternum. 
The subcutaneous ind sterno-mastoid muscles being then drawn 
to the right and left, exposed the tumour, which presented a 
shining aspect, The surrounding parts were detached with the 
linger, and a bistoury, and some arteries were tied. The tumour 
was now r found to adhere closely to the larynx and trachea, 
without the intervention of any cellular substance. The exci- 
sion of the tumour was then performed with the greatest caution, 
by small strokes of the knife; and the portion of it which adhe- 
red to the air-tube was.not removed. Only eight arteries were 
tied during the operation. The wound was tilled with lint, to 
avoid adhesion, that the still adherent part of the tumour might be 



(32 Reduction of Hernia, fy& — Lithographic Plates. [June. 

discharged by suppuration, which accordingly took place. The 
lips of the' wound were afterwards closed, and placed in accurate 
apposition, and the cure was complete at the end of six weeks. 
In the second case, the tumour was much larger — had ailiict^- 
cd the woman from infancy, and was divided into three distinct 
lobules. The immense size of this tumour prevented its entire 
removal at one operation; it was, therefore determined to begin 
with the middle lobe, which was the largest, and appeared to be 
the nucleus of the morbid growth. The operation was conduct- 
ed as in the preceding case, except that the tumour being attach- 
ed to the larynx and pharynx only by loose cellular tissue, there 
was no necessity for leaving any part of it adherent. The 
wound was dressed for adhesion, and w 7 as cicatrized in six 
weeks. The lateral lobes, instead of enlarging, as there was 
reason to fear, diminished considerably, confirming the opinion 
of EVi. Graeefe that the middle lobe formed the nuclus of the tu- 
mour. Perhaps, also, the inflammation consequent on the ope- 
ration, and the obliteration of the vessels that were tied, contri- 
buted to the absorption of the remaining lobules. — American 
'Journal, from Ryan's London Medical and Surgical Journal. 



Reduction of Hernia by the Air-Pump. — Every efficient mea- 
sure in surgery which is calculated to prevent resort to the 
knife, we hail as an improvement of the first order. With Bell's 
improvement in the operation for hernia, we are greatly deligh- 
ted, because, severe, and dangerous as the bistoury sometimes 
is, we had in it a most comfortable and composing hope, on 
which we reclined in perfect case. But we rejoice to find in the 
European Journals several reports since the year 1818 of the 
successful application of the air-pump, for the reduction of stra- 
mulated hernia, which had resisted all the practicable means be- 
fore known except the operation, and when even this had been 
determined on in the consultation of surgeons. In such cases 
the exhausting pump has been applied over- the abdominal ring 
with the effect of speedily and completely restoring the parts to 
their natural portion. 



A scries of twenty, folio, Lithographic plates, illustrating the 
causes of displacement in the various fractures of the bones of 
the extremities, has been recently published in London, by G. 
W. Hind, M. II. C. S. Formerly House-surgeon to the Middle- 
sex Hospital, late curator to the Museum of Anatomy in the 
University of London. 

The subject of this very meritorious scries of Lithographic 
plates is, to exhibit, in a plain and striking manner, the causes 



1836.] Pulsation of the heart of the Edtus. 63 

pf displacement in .he various fractures of the bones of the ex- 
tremities. The w^rk is appropriately dedicated to Sir Charles 
Bell, vviiose pupil the author formerly was. — Med. C/nryg. Iter. 
Oct. p. 487. 

The source, as well as the purpose, is a good one ; and as 
Litpgraphs are now well and cheaply executed in the United 
States, we hope it will not be long before Dr. Doane or some 
other ' ntcrprising American will place this work in the hands 
of American practitioners and pupils- 



Pulsations of the heart of the Foetus. — The Medico-Chirurgi- 
cal Review for July, 1835, contains some observations on this 
p iu in Physiology, by G. O. Fleming, M. D. of the Pancras 
Jniirmary. Dr. F. feels authorized to consider Laenncc's and 
Kir^aradec's double pulsations as erroneous ; because, in the 
f. place, he listened to the foetal heart in Glasgow, and found 
the number of beats to be 140, and pronounced them not double, 
bat single beats ; and each two pulsations were one double beat 
or pulsation. And in the second place, because he had an op- 
portunity of counting the pulse in an infant just born, but which 
had not breathed, and it was 70. The moment, however, at 
which gasping and breathing took place, the pulse became 
much quicker. It was irregular at first, but soon became 140 
in a minute. He concludes, therefore, from these facts, that the 
fcotal pulse is doubled immediately upon the perfect establish- 
ment of respiration. 

On this subject we are clearly of the opinion that Dr. F. has 
mistaken the whole matter. We have often observed the fact 
of the double beat as described by Kirgaradec, certainly less 
loud, but not less distinct than the beat of the adult heart. 
What we mean by double beat, is a pulsation of double the fre- 
quency of that, of the mother. We have also often observed the 
foetal pulse in that stage of semi- suspended animation which is 
presented to our view on the decline of placental circulation, 
and before the pulmonary route was well established. This wo 
have found of various frequency, and in many instances, none 
at all. for minutes. These, however, are only the temporary 
effects of the change the circulation undergoes, and are generally 
of short duration. For so soon as the new route is well esta- 
blished, that frequency of pulse which is determined by the ex- 
isting causes of frequency, is also re-established. We have seen 
a foetus born at the end of the sixth month, in which the pulsa- 
tion of the heart was not perceived at all until some time after 
birth, and never became more frequent than 25 to the minute, 
during the six hours of its life. Can this be considered as deter- 
mining the frequency of its pulse whilst in utero 7 Certainly n^t. 



04 Delirium Tremens, eye. 

It docs appear to us that, setting aside all observation of facts, 
by auscultation before birth, and feeling, after, no one can con- 
template the foetal circulation, and find reason not to know that 
the causes of frequency exist alike before as after birth, with 
only this difference of circumstance, that the oxygenation is more 
direct after than before. The size of the heart is the same, the 
length of the circulating route shorter, and the delicacy of the 
fibre and redundancy of irritability very much 1 he same as bef< >re. 
These are, we apprehend, the chief causes which determine die 
frequency; 



Delirium Tremens. — Dr. Cless, of Wurtemburg, professes to 
have found Digitalis purpurea to be a specific in Delirium Tre- 
mens. Ele\ en, out of thirteen cases in which he administered it, 
recovered ; tlie other two relapsed. A table spoonful of a 
strong infusion was given every two hours. — American Journal. 



Extradrdinary case of Childbirth in old age. — Tn the Boston 
Medical and Surgical Journal for April, 1836. we have the report 
(dated, Whitehall, N. Y. 23d. Feb. 1836.) of a case of pregnancy 
occuring in ihe person of Ann Cook, aged 64 or 65 years. She 
had not menstruated for the last fifteen years, and her la<st child 
was twenty-six years old. She was delivered of a female infant 
the week before the 23d. of February, 1836, and both mother and 
child are now doing well. Her husband is 63 years of age. 



Aloes in Amenorrhea. — Dr. Schonlein, late Professor of Me- 
dicine at Wursburg, is of opinion that an injection of Aloes, (ten 
grains in a small quantity of warm water,) thrown up the 
rectum at the time when the menses ougjfl to make their appear- 
ance, is more certain in its effect than any other emmenagoguc. — 
American Journal. 



SOUTHERN MEDICAL 



AND 



SURGICAL JOURNAL 



Vol. L] JULY, 1836. [No. 2. 

ARTICLE I. 

Observations on Ergot. By M. Antony, M. D., Professor of 
Obstetrics, &c. in the Medical College of Georgia. 

It is not a little strange that, in the republic of Medicine, 
where demonstration is at the head of all evidence and authority, 
there should exist such a contrariety of opinion on a practi- 
cal point, as is manifested amongst physicians at the present day, 
relative to the employment of Ergot. It is nevertheless the fact 
that both its utility and safety have been, and still are, much 
controverted, not only amongst practitioners generally, but in 
some of the public Journals. 

By scrutinizing the facts connected with its ordinary use, we 
shall, however, find many other reasons than the actual demerit 
of this article, why such difference of opinion should exist. 

On commencing an enquiry into this subject, it is but right to 
premise that when we speak of an article of the materia medica, 
we mean a good one; and when of its effects, we relate to its 
judicious administration under proper circumstances and, cor- 
rect observation of its own effects when produced. No article 
should therefore be allowed to suffer in character from the inef- 
ficiency, or the ill effects of an impure, or adulterated prepara- 
tion ; Or the injudicious prescription or improper administration 
of a good specimen, or the partial or superficial observations of 
very limited experience. I will name such of those reasons 
above referred to as have come under my observation. 

1. Pharmacy has not,, done enough for Ergot. This article 
has, in consequence of the high price at which it was first sold. 



6'tf Observations on Ergot. [July* 

and without regard to the selection of that which w r as good, or 
the best means of preserving it from the changes to which it is, 
on exposure in its natural state, so subject, been ushered into 
commerce, and distributed to apothecaries and physicians in the 
rude and careless manner in which it came from the granary 
or the field. In order to shew the proper effects of the article, 
much acquaintance with it is necessary, and great care should 
be used in selecting it of a good quality. But without these, 
he article is commonly ordered by name, and used. 

2. The various preparations made for administration, such as 
tincture, powder, chewing the grains and swallowing the saliva, 
infusion, decoction, &c. all of which do not alike secure the de- 
sired operation. To this paragraph I may add, the great vari- 
ety of the quantity given, and the plan of administering it at a 
single dose, instead of repeating to effect, &c. &c. 

3. Idiosyncrasy. The stomachs of some women will never 
retain it under any circumstances, and the nervous systems of 
others alike forbid its use. These cases are rare. 

4. Excessive exhaustion of the contractile energies of the 
uterus, either permanently, or for a time, 

5. The presence of insuperable mechanical resistance to the 
passage of the child ; as locked head — lodgment of the sagittal 
suture of the lenea-ilio-pectinea — a tonic spasm of the os uteri — 
scirrhosity of the cervex or os uteri, &c. Also, any mal- 
position of the foetus or foetuses which may render the advance- 
ment impossible, without manual or instrumental aid. 

6. I may name as one, not very uncommon, the too long re- 
tention of the liquor amnii, whereby the contractile energies of 
the uterus are exhausted ; and by the timely discharge of which 
these energies are often so recuperated as to give rise to pain, 
without farther assistance ; but when the exhaustion is too 
great for this, their discharge will often enable Ergot to act, 
when it could not, during their retention. This is done by that 
recuperation of passive power in the uterus by rest, which was 
before too far exhausted by over distention. 

7. Too great exhaustion from previous haemorrhage, as is 
often the case when the placenta is attached to the os uteri. 
In the early haemorrhages from this cause, it has been often 
found to stop the flowing of blood ; but after great losses are 
sustained, its powers are less available. 



?836.j Observations on Efgot. 67 

8. Limited experience ; or partial, careless observation on the 
experience. 

9. The cause of the slowness of the labour in which it is 
grveiii Labours arc, cet. par. generally rendered more tardy 
by the previous death of the foetus.* 

10. The foregoing character and circumstances of the la- 
bour ; as the too long resting of the head in the bones, or pressure 
of the umbilical cord, &c. so as, in either case, to kill the child; 
and the previous death of the child from any cause. 

It appears only necessary to direct attention for a moment 
to these circumstances, which every extensive practitioner must 
have had frequent opportunities of witnessing, to perceive at 
once how it is, that in some of them the power must often 
Fail to produce its peculiar effects ; and how, in many cases, it 
also occurs, that the child is still-born. Judging, therefore, from 
the very nature and frequency of these circumstances, and the 
reports and opinions of practitioners, together with my own 
observation, I am led to the conclusion that most practitioners 
prescribe the article only, or chiefly under some of those cir- 
cumstances which contra-indicate its efficiency, and its success 
in saving the child ; or, at least, in cases which, in their very 
nature, render these ends physically impossible. 

Another cause of the death of the foetus, which has been 
attributed to Ergot, and which should not be passed over in 
this brief notice, is the very common, and indeed fashionable 
neglect of that manual assistance which is often abundantly 
necessary for preparing the passage and removing its resist- 
ances ; and that judicious selection of position for the woman 
most calculated to expedite the passage of the foetus through 
the second stage of labour. 

Jalap as a cathartic, and Tartar Emetic as an emetic power, 
are not, in my hands, more true to their several purposes than 
is Ergot in the increase, or production of parturient effort, or 
expuhory action of the uterus. After much observation on the 
use of this article, I have fixed on administration in the form of 
decoction. Always giving it in divided doses, I am not very par- 
ticular as to the precise strength of the decoction ; which, how- 
ever, I vary according to the circumstances of the particular 

* This, and the next paragraph, are applicable t<? the charge against the 
safety of Ergot. 



68 Observations on Ergot. [July, 

case — repeating or enlarging the dose by my judgment at the 
moment of giving each. This is, however, the strength at which 1 
aim, without being particular to weigh the Ergot every time. 
$ Ergot 3ij 
Water Oj, put into a suitable vessel, cover and boil 
four or five minutes. Dose 5 ss to siss every fifteen or twenty 
minutes, increasing as need may be. When the stomach seems 
disposed to reject the dose, I find it proper to reduce the propor- 
tion of water to one half, and the quantity of decoction given at 
each dose accordingly. 

Under proper circumstances, after the administration of the 
first or second dose, the whole extent of the uterus will be found; 
to harden and assume its own globular form and prominence, in- 
stead of the shape of the fcetus within. The membranes too, if 
not previously ruptured, now become more tense ; and if they 
have been ruptured, the presenting part of the child will be 
borne forward with -more steady pressure. Soon after this, 
distinct, but short pains come on. These gradually lengthen 
until they nearly or entirely fill the space which ordinarily in- 
tervenes — in short, the last, long, effectual expulsory effort is 
produced, and the child is born. These, I say, are the common 
characters of its effects ; but sometimes, one, two, or three ex- 
pulsory efforts are very promptly produced, and the second 
stage of labour is completed. 

This treatment, and these observations, are applicable to 
those cases of labour in which the whole powers of Ergot are 
needed. But my use of it is not by any means limited to such 
cases. I prescribe it in almost all cases wherein there is less 
promptness and energy of uterine contraction than is desirable ; 
merely for bringing the efficiency of action up to that of ordi- 
nary, natural, and prompt cases. 

Excessive haemorrhage after delivery is a most fruitful source 
of distress, alarm, and, with many, even of danger. In cases 
where I have reason to apprehend this, (and which may be 
often foreknown,) and in which depiction is not indicated, I ad- 
minister Ergot in due time to secure its prompt effect, about, 
the close of the second stage of labour, with the best effects. 

In many cases there is a distressing hcad-ach, (differing es- 
sentially, however, from that state of head and general system 
which threatens puerperal convulsions.) and which seems to 



1836.1 Observations on Er+ot. 61) 

take the place of uterine contractions ; and the regular form 
of labour pains is not marked at all. In these cases I have often 
succeeded in so invigorating the uterine action, as to relieve the 
distresses of the head, and secure prompt, regular, and efficient 
parturient effort. 

In cases wherein such a disproportion exists between the 
foetal cranium and maternal pelvis, that the former must be 
elongated considerably by uterine effort, or an appeal to instru- 
ments become necessary for the accomplishment of the second 
stage of labour, I often resort to the use of Ergot for the purpose 
ot securing the little additional power necessary for this effect, 
with tar iess danger than to instrumental delivery. 

In ail oi" these cases, (which I only mention here to shew the 
manageableness and utility of Ergot,) and many more which I 
might name, I use the Ergot with the greatest confidence, ari- 
sing out of perpetual demonstraiions of its safety and its utility. 

The most prompt and regular effects which I have ever deri- 
ved from Ergot, were from the use of that preparation which 
w r as first vended by the northern druggists about twenty years 
ago, in the form of a fine dry powder, well secured in small 
bottles of two or three drachms. Less of that was found ade- 
quate than of the best which we now receive. This prepara- 
tion is no more to be had of our Druggists ; and I now select 
from the latest supplies, those grains which are dry and hard, and 
free from rot, worms, mould, and very strong urinous odour; 
and which, on being broken, exhibit a white amylous fracture. 
The preservation, whilst fresh, in small close bottles, is so supe- 
rior, that it never should be allowed to be found in commerce 
in any other form ; and it is earnestly hoped that the College of 
Pharmacy will take the subject into consideration. Attention to 
this alone would cause Great benefit to be derived from its use in 
thousands of cases which now suffer unnecessary misery, injur}'. 
or death, from want of its valuable effects. 

This powder I also used in decoction, but in much less quan- 
tity than I now use the article. 

So fully satisfied am I of its not injuring the child, (and this 
assurance is not from abstract reasoning, but the facts of obser- 
vation,) that in cases which require additional haste to relieve 
the child's head, or the umbilical cord, from dangerous pressure 
in the pelvis, I often administer it for the sole, final purpose of 
saving its life. 



?0 Remarks on Empiricism. [July 



ARTICLE II. 



Remarks cm Empiricism. By Joseph A. Eve, M. D. Pro- 
fessor of Therapeutics, &c. in the Medical College of Georgia. 

To such a fatal extent does empiricism prevail in this coun- 
try, at the present day, that it becomes the duty, not only of the 
physician, but of the philanthropist, to enquire into its causes, 
and suggest methods for its suppression. 

In this enlightened age, when such splendid achievements 
have been made in the arts and sciences, and the state of medi- 
cine so highly improved as almost to have arrived at perfec- 
tion, incredible as it is, and disgraceful to this land of light and 
liberty, where no shackle, no restraint is thrown upon the diffu- 
sion of knowledge, empiricism, more grossly absurd and des- 
tructive than ever disgraced the dark ages, still exists, in defi- 
ance of legislative enactment. 

Were the history of quackery, even in this State, faithfully 
registered, its annals would be too black, too replete with horror, 
too appalling for perusal — they would record the cold-blooded 
slaughter of hundreds, if not thousands, of persons, whose 
lives have been deliberately and cruelly sacrificed, by the most 
ignorant and presumptuous charlatans that ever infested any 
country in any age ! 

In tracing the causes of this tremendous evil, much doubtless 
is attributable to the incompetency and dishonesty of physicians, 
many of whom, by their unskilfulness, negligence, and conse- 
quent ill-success, bring contempt and reproach on the profession, 
and compel their employers to resort to empirics for the bene- 
fits they fail to afford, and the latter arrogantly but vainly pro- 
mise : others, false to science and humanity, have renounced 
their profession and adopted empiricism ; or, becoming all things 
to all men, have, still more basely, declared themselves ready 
to practise their profession, or quackery, as ordered by their 
employers. 

These physicians are divisible into two classes, — the first 
grossly ignorant — the second criminally dishonest — the former, 
too deficient hi knowledge or intelligence to comprehend and ap- 
ply theprinciples of medicine, become perplexed, embarrassed and 



183G.] Remarks on Empiricisni. 71 

dissatisfied with their unsuccessful attempts at regular practice, 
and are therefore happy to adopt a method that requires nei- 
ther sense nor learning; for the principles of medical science, 
though to the learned and intelligent, lucid, beautiful and har- 
monious, arc to the ignorant and obtuse, all darkness, inconsis- 
tency, confusion and chaos. 

Such practitioners, as well as their employers, arc objects of 
compassion — we pity, and pass them by. 

The second class consists of those who, actuated by sordid 
love of gain, are willing, taking advantage of popular prejudice 
and credulity, to sacrifice principle to profit, Mq to lucre ! — for 
such deep, dark, demon-like depravity, words fail in expression 
— language has no adequate terms of horror — earth no appro- 
priate retribution ! 

But the ruinous prevalence of empiricism is, by no means, 
wholly chargeable against the profession — it is mainly to be 
accounted for by the fact that the community are less informed 
on medicine, than almost any other subject. With respect to 
the other learned professions, they are incomparably more en- 
lightened. 

Divinity is more or less the study of all — the great Text- 
Book, containing all the principles and maxims of the science, is 
in the hands of every one — besides, ample instruction is afforded 
from the pulpit, in the Sabbath school, and by religious periodi- 
cals, which are extensively circulated and generally read. 

People in general are much better acquainted with law than 
medicine, a considerable knowledge of which is acquired by 
attendance on Courts, which is at least equivalent to attending 
lectures — they read legal more than medical books, and arc more 
assiduous in endeavouring to acquire the former than the latter 
species of knowledge ; for such is human nature, strange and 
inconsistent as it may appear, that most persons take more in- 
terest and devote more attention to that winch concerns pro- 
perty than health, except during sickness, when they are dis- 
qualified for the pursuit or acquisition of knowledge. 

As the soul is superlatively superior to the body, and its inter- 
ests paramount to all others, divinity, as it involves eternal happi- 
ness, is that study which commands the first attention of alL 
men ; but certainly next to it, of all human knowledge, medicine 
is that in which man is most deeply interested, and whficH 



7~ Remarks on Empiricism. [July, 

ought therefore to be neglected by none. We would not be un- 
derstood to say that all men should become physicians ; but that 
all men, as far as opportunity is afforded them, should read me- 
dical books, attend lectures, and acquaint themselves with the 
general principles of the science, so as to be qualified to become 
to some extent, guardians of their own health, and to make a ju- 
dicious selection of a physician, when medical aid is required. 

Of the principles of medicine, people generally are totally ig- 
norant ; few ever look into a medical book, unless it be some 
popular work on practice, or some empiric production, both 
of which are calculated to lead to error. It has often been 
said, a little knowledge is a dangerous thing, that persons should 
be profoundly learned or know nothing — this is certainly true 
as respects a little knowledge of practice, without the least ac- 
quaintance with principles. 

A little knowledge of practice derived from popular writers, 
leads to arrogance and presumption, and is often productive of the 
most dangerous and disastrous consequences ; whereas a knowl- 
edge of the true principles of medical science, as of philosophy in 
general, inspires modesty and diffidence : but while it prevents its 
possessor from ignprantly arrogating the weighty and responsi- 
ble offices of physician, to the destruction of others, it qualifies 
him to discriminate between the scientific practitioner and the 
vain pretender, whether in or out of the profession, and is thus 
a source of much safety to himself. 

Physicians have the best opportunities of observing, and are 
best qualified to discern the ruinous effects of empiric practice : 
and, moreover, as guardians of the public health, feel under most 
solemn obligation to expose and prevent them : — and different 
methods have been suggested to deliver society from this evil, 
more dreadful in its ravages than pestilence or war. 

Although it is the duty of wise and virtuous legislators to enact 
laws to protect the safety of the people, legal prohibition will al- 
ways prove ineffectual for the suppression of quackery until the 
public mind is enlightened on the subject. " Empiricism (says a 
cotemporary waiter) must flourish until the mass of the people 
are educated to a point or stage above it."*' We have long 

*The same author further observes, "we have always considered as highly 
complimentary to the general intelligence of our city, (Philadelphia,) 'that 
the Thornpsonian follies, and perilous administrations of stewings, and "Num- 
ber 6," together with the species of medical monomania, called Homeeopa- 



1830.] Remarks on Empiricism. 13 

thought that there should be attached to all colleges and univer- 
sities, Professorships of Chemistry, Botany, Anatomy and Phy- 
siology, and the Principles of Medicine; nor should instruction 
in these sciences be confined to those institutions ; there ought 
to be public lectures delivered on each of them in Lyceums, that 
should be established in every town and county, for the pro- 
mulgation of useful and salutary knowledge among all classes 
of people. We should then no longer behold, as at present? 
porsoas intelligent and well informed on other subjects, become 
the unfortunate dupes of ignorant and contemptible quacks, 
yielding assent to the preposterous and ridiculous absurdities of 
Thorn psonianism, and submitting themselves and families as 
victims to this barbarous system of immolation. So far from 
enfightehed members of society being deluded by these pre- 
sumptuous pretenders, even labouring men would possess too 
much knowledge to be deceived by such vile impostors. 

A very moderate knowledge of Chemistry and Botany would 
disabuse the community of the false and ridiculous impression 
which empirics constantly endeavour to impose on their credu- 
lity, that is, the universal mildness and safety of all vegetable 
substances, and the mortal potency of- all mineral medicines — 
they would soon learn that plants and flowers furnish some of 
the most subtle poisons and violent remedies — whilst many of 
the simplest and gentlest are derived from the mineral kingdom. 

Very little insight into the extremely delicate and compli- 
cated structure of our organs, and the functions exercised by 
them, could not fail to render obvious the peril of ignorantly 
and carelessly tampering with them, and the necessity of the 
most profound knowledge to enable a physician to comprehend 
and correct the changes wrought by disease. 

And but a slight acquaintance with the principles of medicine, 
founded on a knowledge of the organs and functions, and the 
modifying powers of medical agents, would be required to shew 
the absurdity and danger of empiric practice. 

We repeat, the only sure and effectual method to suppress 
empiricism, is to enlighten the people. Legislatures would ac- 
complish much more, indirectly, by establishing medical pro- 

thic system, have made fewer inroads among us than in most other places. 
Ji»t these and the like impositions on human credulity, seek for a refuge in 
■ irts of ignorance and moononisnj. 
10 



74 AeTJi&rks oft Empiricism, [_ J ui y v 

fessorships in all colleges and large schools, and by directing 
attention to the dissemination of science, than by the most severe, 
penal statutes. Indeed, so nugatory has legislative interference 
proven, that many members of the profession, as much as any 
opposed to empiricism, advocate the policy of removing al] 
restraint, and allowing the evil to proceed unchecked until it 
effects it's own cure, which they believe would soon be the 
result, if all opposition were removed. 

Physicians are placed in a peculiarly delicate situation, and 
the part they are called on to act is difficult and embarrassing — 
duty and interest both require them to oppose quackery in 
every form — but it is necessary for them to exercise the great- 
est caution, and moderation, or they will be accused of selfish 
and sinister motives, and the cry of persecution be raised, to the 
great benefit of the empiric ; and, on the other hand, without 
the most uncompromising firmness, in refusing to acknowledge 
his claims to professional courtesy, they will be justly charged 
with sanctioning and approving empiricism . 

It has been proposed by some physicians to obligate them- 
selves to each other not to attend a patient that had been attend- 
ed by an empiric — this, however, is contrary to the plaincsf 
dictates of humanity, and to the most obvious professional obli- 
gation : — if we are solemnly bound, when called on, to bind up 
the wounds and assuage the sufferings of the guilty suicide, are 
we not of him who has been unwittingly betrayed into the hands 
of the assassin ? 

But even did duty leave us at liberty to withhold our ser- 
vices, we would be denying ourselves one of the very best 
opportunities afforded of proving to the world the superiority 
of science over empiricism, for a large number, if not a majority 
of cases, given over by the empiric, may be cured by the 
scientific physician. 

The proper course for physicians to pursue is to labour 
diligently and faithfully in their calling, considering their lives 
as consecrated to the sacred service of humanity, and to deport 
themselves with respect to empirics so as to avoid on one hand 
the slightest appearance of persecution, and on the other, the 
faintest shadow of sanction to their pretensions. But we con- 
ceive it is their duty, on all appropriate occasions, to expose 
errors that endanger life, and explain patiently and endeavour 



1836.] Remarks on Empiricism. 75 

to promulgate correct doctrines, relying confidently on the 
power of reason, the omnipotence of truth, and the certain tri- 
Limpb of common sense. We are aware that many of our pro- 
fessional brethren are opposed to the plan we suggest of endea- 
vouring by all means to disseminate medical knowledge, and 
render all chsses more intelligent on the subject of medicine. 
We regret differing with our brethren, but after much reflection 
we are convinced that every method devised for the suppression 
of empiricism, will be found altogether inadequate and futile, 
until the people are enlightened. Empiricism, we say, is found- 
ed and supported by ignorance, and when once the foundation 
and support are swept away, however high-towering or wide- 
spreading be the superstructure, it must fall — before the light of 
knowledge quackery will vanish as me sable shades of night 
before the rising sun. To physicians the foregoing remarks 
are addressed ; the object of which is to solicit co-operation ox 
to invite discussion. 

If we are wrong, we desire to have our opinions corrected ; 
but if the views we entertain are correct, and we are fully per- 
suaded investigation will establish their correctness, it is desi- 
rable that they should be properly appreciated by the profession. 

Physicians are the depositories of medical knowledge — from 
them it must emanate and be communicated to others. Physi- 
cians must devise every plan, and move every enterprize for its 
dissemination. Let physicians memorialize Legislatures for 
the establishment of professorships in schools and colleges, and 
the building of Lyceums. Let them deliver public lectures on 
medicine, and labour to create in society a taste for medical 
literature. Let physicians adopt this course — let them speed 
the diffusion of medical knowledge through all classes of people, 
and the world will soon awake to its importance ; medical books 
shall constitute a part of every library, and no person be consi- 
dered to have received a liberal education who has not attended 
jnedical lectures — then and then only, shall our profession be 
duly appreciated, empiricism receive deserved reprobation and 
■contempt, and empirics be no more tolerated than pirates 07. 
xobbers in civilized lands. 



'Flier momelrical Observations. 



JmV, 



ARTICLE III. 



Thermomelrical Observations for April, 1836, kept in Burki 
County, Geo. Extract from the Journal of a Geological 
and Agricultural Survey. By Professor J. M. Cottixg. 



Tf) 


►— 1 


?7? 


^ 1 


C 


*o 


e 


o 
p 


5 


q. 


S3 

ir. 




o 


CD 


3 


a> 


o 








o 






• 


*r 


* 


• 



REMARKS. 



1 


52° 


60° 


2 


57 


68 


3 


62 


72 


4 


62 


71 


5 


48 


64 


6 


48 


72 


7 


54 


56 


8 


54 


64 


9 


60 


72 


10 


61 


70 


1) 


51 


72 


12 


50 


58 


13 


64 


68 


14 


59 


74 


15 


62 


81 


16 


61 


70 


17 


62 


60 


18 


53 


64 


10 


74 


72 


20 


64 


61 


21 


63 


73 


22 


50 


68 


23 


58 


78 


21 


54 


82 


25 


61 


82 


26 


68 


82 


27 


63 


85 


28 


64 


84 


29 


68 


84 


3^ 


61 


80 



62° 

72 

72 

68 

60 

68 

52 

70 

69 

07 

62 

56 

73 

76 

77 

68 

55 

67 

67 

61 

69 

71 

70 

78 

75 

76 

79 

78 

79 

78 



56° 


75 


64 




66 


5 


66 


3 


53 




58 




53 


75 


61 




59 




65 





These observations have been made in 
different parts of the county, where the 
observer happened to be. In all cases the 
thermometer was placed in the shade, 
and with a northern aspect. The mean 
heat was obtained from a variety of ob- 
servations during each day. 
Mean heat of April, - - - 62° 61 
Quantity of rain fallen during the 

month, inches, 1.83 

Number of cloudy days, - - - 3 

Rainy days, - - 1 

Foggy mornings, 2 

Thunder showers, 7 

Prevailing winds, E., SE., S. and SW. 

In running the East and West section 
line, from Shell Bluff, on the Savannah 
river, to Jefferson county line, the same 
formation was found on each extremity 
of the line ; consisting of shell limestone 
and the genus Ostrea, of different species. 
On the extremities of this line, vegeta- 
tion is nearly a fortnight earlier than on 
the middle. The Buck-eye (JEsculus 
pallida) was in blossom at the two ex- 
tremities on the 29th of March, and in 
no instance in the middle until the 10th 
of April. 

The tern pern lure of springs issuing 
from the shell limestone formation, was found to be uniform at. 



60 
53 

68 
66 
69 
65 
58 
59 
73 
63 
69 
59 
67 
66 
70 
74 
73 
73 
72 
69 



47 

33 

5 



5 
5 

75 
5 
1 
4 
5 

33 



while tf 



lose ] 



ssuine from the marine sand or crag formation. 



the temperature was between 54 and 58 degrees. 



1836.] Thermomelrical Ob$erva3ofi&. 77 

Li all cases, it has been found, in the survey of Duike co 
that the forwardness of vegetation, and the high temperature of 
the water of springs, indicate the existence of a bod of limestone 
or calcareous marl. This fact is analogous to what has been 
observed in England and other countries in Europe. Bakewell, 
in his Geology, remarks that it is a well known fact, that the 
vegetation of perennial grapes, is, at least, a fortnight sooner on 
limestone and sandy soils, if not extremely barren, than on 
clayed, or even deep rich soils. It is equally true, though not so 
generally known, perhaps, that the difference is more than 
reversed in the autumn. This effect may be ascribed, with 
much probability, to the rich or clayed soils absorbing heal 
slowly, and parting with it again more reluctantly than the 
calcareous soils, owing to the greater quantity of moisture in 
the clay, which is a bad conductor of heat. 

[We take pleasure in presenting to our readers the above 
Meteorological Ephemeris and remarks, from the journal of our 
esteemed and scientific friend. Professor Cotting. This gen- 
tleman, who is devoted to the natural sciences, has for some 
time been engaged in making a Geological survey of Burke 
County, and designs, as we understand, to extend those investi- 
gations to some other parts of the State. The age, experience^ 
and extensive acquirements of Professor C. in the natural 
sciences, of which he has for many years been a successful 
teacher, fully warrant the belief that these researches cannot 
fail to afford results of deep interest to the State, the natural 
history of which has hitherto rested untold. We hope to draw, 
from time to time, from the same source, matter of increasing 
interest, as his investigations are extended; and indulge the 
hope that our State will extend to this able and worthy indivi- 
dual such patronage as shall secure to herself the incalculable 
benefits of his services in making a general survey. — Ed.] 



78 Removal of a large fibrous Polypus^. [July 



ARTICLE IV. 

Removal of a large fibrous Polypus from the base of the Cranium. 
By Paul F. Eve, M. D. Professor of Surgery in the Medical 

College of Georgia. 

Some of the particulars of the following case, having been 
verbally reported at the last meeting of the Medical Society of 
Augusta, a wish was expressed, to have them furnished the 
Southern Medical and Surgical Journal for publication — and 
as they may not be devoid of interest to the profession, I have 
consented to comply with the request. 

Mr. Jonathan Stanford, now twenty-one years old, states that 
from early life he could not breathe through his right nostril. 
After having applied to several physicians of his neighbourhood, 
and tried every thing that promised relief, he was induced to 
visit the Faculty of our Medical College, in April, 1835. A few 
days after his arrival, an attempt was made to remove the por- 
tions of a Polypus projecting anteriorly into the naris of the 
right side, as well as posteriorly and downwards upon the soft 
palate, which latter portion could be readily felt by the finger 
introduced into the mouth and passed upwards alongside the 
uvula. By the use of forceps, &c. some inconsiderable portions 
were torn away, which permitted the patient to breathe through 
the nostril affected, after the slight inflammation produced by 
the operation had subsided. The part of the tumour directed 
backwards was found to be very large, and from the difficulty 
experienced in seizing it properly, it w T as deemed inexpedient to 
proceed further with the operation at that time, and the patient 
returned home. 

In October following, about six months after this very partial 
relief was afforded, Mr. Stanford again visited us; having now 
the antrum highmorianum of the right side very much distended, 
the eye of the same side being somewhat protruded, turned 
upwards and outwards, and the molar teeth depressed below 
their natural level, the Polypus also projecting both anteriorly 
and posteriorly in the nostril of the affected side. In the pre- 
sence of the class then attending lectures, an opening was made 
into the antrum, and a portion of the Polypus extracted from it. 



I9te.| Removal of a large fibrous Polypus. 7<J 



Tiic soft palate was next slit up for about three-fourths of an 
inch, and as the united efforts of several could not draw away 
that part of the tumour directed backwards, either with forceps, 
ligatures or hooks, a considerable portion was removed with 
curved scissors. In a few days, our patient had sufficiently 
recovered to return home, the distance of about thirty-five miles. 

About six months after this, Mr. Stanford again visited 
Augusta. A large tumour now protruded out of the antrum 
under the cheek, producing great deformity ; he had had an 
attack of congestive apoplexy ; the sense of hearing on the right 
side was diminished; the carotid artery of the same side was 
pushed outwards from its natural situation ; and both nostrils 
w T ere closed up, the patient breathing through the mouth. Mr. 
S. and his friends having been apprized of the nature and extent 
of the operation required for the removal of his affliction, and 
being persuaded from experience that nothing less promised 
relief or even a continuance of life itself, gave their consent to 
submit to whatever was thought necessary. 

On the 19th of May, assisted by Dr. Dugas and Messrs. 
Alfriend, Roberts and Byrd, Students of Medicine, the opera- 
tion was commenced by making an incision from one inch 
below the internal angle of the right eye, and extending it down 
through the upp^r lip. The knife was then carried from the 
angle of the mouth on the same side upwards and backwards to 
the lower edge of the malar bone, dividing all the soft parts for 
two inches or more. The flap made between the two incisions 
was dissected up and reflected upon the right eye. The tumour 
projecting from the antrum being thus fairly exposed, a very 
strong tape as a ligature was put around it in this cavity, and 
by very severe and forcible traction a large piece of it was torn 
off from the mass in the nostril. The haemorrhage was very 
great ; but in this, as in all other instances, except a few small 
arteries in the lip which required compression, it was controlled 
by injections of a strong solution of sulphate of zinc. Finding 
it *iow impracticable to seize the Polypus either through the 
opening already made, the nostril or the mouth, a peculiar 
instrument was resorted to, with which it was proposed to cut 
away the bones. With a small pair of pruning shears, the su- 
perior maxillary bone of the right side was divided between the 
first and second incisor teeth, then the nn sal pror*Pss of iho same 



HO Remaval of a large fibrous Polypus. [July* ■ 

bone transversely by passing one blade of the same instrument 
>into the antrum, after which the alveolar process with six 
teeih, (the wisdom tooth not being developed;) was gradually 
detached from the malar bone and the pterygoid process of the 
sphenoid bone. Tiie palatine process of the superior maxillary 
bone, and the palatine plate of the palate bone, were now re- 
moved, and the soft palate completely divided through the 
centre. It being evident from repeated efforts with forceps; 
ligatures and hooks, that the Polypus could not even now be 
dragged away, after separating its slighter attachments from 
the surrounding parts, the curved scissors were employed, and 
it was found intimately adhering to the basilar processes of the 
occipital and. sphenoid bones, arrd also to the internal plate of 
the pterygoid process. 

The Polypus was of a very irregular shape, having several 
projections ; one into each nostril, the large one into the right 
antrum, which had been torn off, besides the large body resting 
upon the soft palate and attached as already mentioned ; and 
what was very remarkable, there was a small nipple-like pro- 
cess, extending into the left antrum. It was filled with large 
venous sinuses, and quite fibrous, particularly at its bony at- 
tachments. It was about the size of a man's fist — after being 
macerated ten or twelve days, and deprived of all its blood, it. 
weighed three ounces, three and a half drachms. It can be 
seen in the Museum of our College. 

In dressing the wound, three common interrupted sutures 
were made in the soft palate, and five more with adhesive 
strips to the two incisions on the face. 

The patient, who bore the operation with great fortitude and 
resignation, had fainted several times, and did not folly revive 
until the third day, when he was considered out of danger. A 
little more than three weeks after the operation he returned 
home ; the external incisions had healed, but that in the palate 
was still open. There was little or no deformity ; the right 
cheek was neither depressed nor swollen. It is proposed to 
attempt hereafter, the operation of Roux, called Staphyloraphy, 
to remedy the defect in the soft palate. 

Ausnistt^, June 1th, 1836. 



1386.] Purulent Ophthalmia of Infants. 81 



ARTICLE V. « 

Purulent Ophthalmia of Infants. By L. A.Dugas, M.D. Profes- 
sor of Anatomy, &c. in the Medical College of Georgia, &c. 

The obstinacy with which the purulent Ophthalmia of infants 
not unfrequently resists the ordinary modes of treatment, in- 
duces me to present a few cases in which the chloride of soda has 
been most signally successful. I am not aware of its having 
been hitherto used m this disease. The w r cll known anti- 
suppurative properties of the chlorides suggested the prescrip- 
tion, and its uniform success in the small number of cases I 
have had to treat, causes me to regret that I have had so few 
opportunities of testing it. 

Case I.— 15th of December, 1834. Mr. J. H.'s child, 
when five days old, experienced in both eyes the ordinary 
symptoms of Purulent Ophthalmia, which progressed and con- 
tinued four weeks, notwithstanding the usual remedies. Mucila- 
ginous poultices and washes, were first used ; subsequently, lead 
water, alum curd, laudanum and water, breast milk, rose 
water, &c. &c. I now saw the infant, and found her eyes 
suppurating at least a table spoonful each in twenty-four hours. 
Palpebral so much swollen as to overlap each other considera- 
bly and render it impossible to separate them sufficiently to 
examine the globe of the eye. — Child well in other respects, 
but cries very much ; ordered the eyes to be bathed every hour 
or two with tepid diluted chloride of soda, ( I ss to a quart bottle 
of water.) During sleep a bit of linen to be placed over each 
eye, and kept moist with the same solution. The bowels to be 
moved every other day with castor oil. 

16th, the quantity of pus has notably diminished. 

19th, child cried so much last night, as to cause the eye-lids 
to become swollen — discharge still diminished — mother so un- 
easy that she msists on applying blisters the size of 12 1-2 cts. 
coin to each temple — chloride continued. 

20th, eyes rather worse — blisters dressed with cerat. simp. 
— chloride solution. 

23d, blisters quite well — pus much diminished — eye-balls maj 
be seen — somewhat inflamed over the sclerotica. 
11 



S2 Pvm^rJ Ophthalmia of Infante. [July;* 

26u . still improving rapidly. 

30lh, palpebral swelling entirely gone — no evidence of in- 
flammation in the eye — no pus, nor agglutination — case dis- 
charged. 

Note. It is worthy of remark that the disease was aggra- 
vated during the active stage of the blisters, and that its subsi- 
dence was in a direct ratio with the diminution of excitement in 
the blistered surfaces. The temporary swelling of the eye-lids, 
which led to the application of the blisters, was evidently caused, 
by the excessive crying of the child the previous night. 

Case II. — 18th January, 1835. Mr. G. W. C.'s infant, six 
weeks old, affected with purulent Ophthalmia of both eyes, 
since the fifth daV after birth. Has had applications of mucil- 
ages, breast-milk, calomel, laudanum and water, &c. to the- 
eyes, with only temporary relief. The palpebral arc now very 
much swollen and overlap ; the inflammation extends from them 
over the eye-balls, as may be seen by separating them ; suppu- 
ration at least a table spoonful per day from both eyes — treat- 
ment, chloride of soda and 01. Ricini, as in case No. 1. 

27th. Have not seen the child since the above date, but am. 
informed by the father that the chloride " acted like a charm ;' T 
that the suppuration has entirely disappeared, that the inflam- 
mation and swelling of the eye-lids i. r moved, and in short, that 
the child is well. 

Case III. — 20th May, 1835. Nancy's infant, (belonging to 
Mrs. B.) now thirteen days old, has had purulent Ophthalmia 
six days, and has been subjected to the mucilaginous treatment 
without benefit. Eye-lids now so much swollen as to overlap 
considerably, and to render any separation sufficient to see the. 
cornea impossible — purulent discharge very abundant — Ik al k 
otherwise good — ordered chloride of soda, as above, without 
purgation. 

23d, discharge much diminished. 

28th, perfectly well. 

Case IV.— 20th March, 183G. Mr. L. P. D.\s negro woman 
Pat, on the 5th inst. gave birth to a fine child, who, on the 13th, 
was taken with purulent Ophthalmia. The disease has conti- 
nued increasing to the present time. The eyes have been 
bathed with breast-milk — nothing else done. They are now 
discharging immense quantities of pus — eye-lids so much swollen 



1836. J Mgftor Se?ato's Discovery. 8B 

as to prevent their separation — prescribed the chloride wash, as 
above — nothing else. 

1st April, eves were well, but being neglected, have again, 
-commenced discharging a little — chloride re-applied. 

5th, perfectly well. 

Case V. — 1st March, 1836. Mrs. P.'s infant, fourteen days 
old, has suffered five days from purulent Ophthalmia of one eye. 
T : ie palpebral and eye are both inflamed — pus abundant. The 
o f her eye slightly irritated. Breast-milk alone has been used. 
The chloride of soda, applied a week to both eyes, gave complete 
relief to the diseased, and prevented the development of thfi 
affection in the other. 



ARTICLE VI. 

Signor Segato*s Discovery. 

We are indebted to our friend, Dr. A. Cunningham, of this 
^ity, for the following very interesting communication, from our 
literary, scientific, and highly valued fellow-citizen, the Hon. R. 
H. Wilde, now in Rome. Although a considerable part of 
this paper is not strictly adapted to the pages of a medical 
periodical, still, on account of its great interest, and its necessary 
connection with that part which is of incalculable importance to 
the naturalist, and to the anatomist, we have determined on not 
interrupting its intigrity by publishing a part only ; and therefore 
present it entire for the gratification of our readers. 

To the Editors of the Southern Medical and Surgical Journal. 

I have just received from our friend the Hon. Richard H. 
Wilde, an abridged account of Signor Giromalo Segato's dis- 
covery, by his friend the Avocate Pellegrini. And inasmuch 
as it is one of great importance in the science of medicine, as 
well as to the naturalist, I cannot do better than offer it for 
publication in your Journal. Further proof I apprehend will 
«ot be required than is appended to the abstract* A. C 



84 Signer ftcgato's Discovery. [July, 

Giromalo Segato is a native of Yedano, a romantic village 
situated about seven miles from Belluno, in the Lombard- Vene- 
tian Kingdom. At the age of eighteen he attended the chemical 
and mineralogical lectures of Professor Tommaso Antonio 
Catullo, at Belluno, and accompanied that eminent person in 
various excursions to the mountains, for the purpose of collect- 
ing minerals and fossils. Even thus early, he gave indications 
of his passionate love of science, by exploring, alone, the moun- 
tains of Feltrino, and the environs of Agordo, returning laden 
with objects for the most part deserving the attention of the 
naturalist. In the short space of two years, 1812-1813, he col 
lected above a thousand specimens, among which those of fossil 
shells were the most valuable. He discovered a mode entirely 
his own, of detaching them from the hardest rock, without 
breaking, or leaving any part of the shell behind. His thirst for 
chemical and mechanical knowledge was insatiable, but Belluno 
was too confined a theatre for his genius, and he often lamented 
that his lot had not fallen in some pla( c where he could have 
executed some of the many experiments that occurred to him. 
Impatient of these obstacles he at length abruptly quitted his 
country and parents, and in 1820 his passionate love of travel 
led him into Egypt. An interesting outline of his journey is 
preserved in a letter to his brother, dated at Cairo on the 2Gth 
of December in that year, in which he says : — 

" I will give you a sketch of my travels, of which you have 
already heard something by my letters written from Cairo at 
the moment of my departure, from the cataract of Assouan, 
from the island of Philoe, and from Abki, if they have reached 
you. 1 left Cairo on the 6th of May last, making part of an 
expedition destined for the conquest of Sennaar. To me, among 
others, was intended to be entrusted the superintendence of cer- 
tain works at the second cataract, which the Pacha wished to 
have constructed for the purpose of facilitating trade and the 
passage of troops. Handsome rewards were proposed to me, 
"but I declined them, desiring to avoid all restraints on my move- 
ments, and having no good opinion of the folks I should have to 
deal with; in which, as it turned out, I was not mistaken, for 
at the second cataract, disgusted with the dishonesly of one of our 
Italians, whose plan was plainly avowed by himself, I abandoned 
the expedition. But let us quit this subject and return to my 



1836.] Signor Segaio's Discovert/, 85 

journey* Leaving Cairo then, I passed on to upper Egypt, 
traversing the Tolcmaid, the Thebaid, and Sayd, and visiting 
the remains of thirty magnificent ciiies, as Ginqpoli, Antiohq, 
Ermbpoli Magna, Tani-Eptanomica, &c. &c. Arriving at 
Assouan, I pitched my tents near those of his Excellency Kihia- 
Key, with whom I partook of a repast. I visited the well of 
the San, the sacred island of Philoe, the ancient and magnificent 
place of initial ion- into sacred and sacerdotal mysteries, at pre- 
sent involved in the deepest obscurity. After a few days stay, 
I departed with his Excellency. I was the first who ventured 
to ascend the first cataract, being drawn against the stream by 
about two hundred men. The 20th and 21st we were at Qua- 
labseh, a place precisely beneath the tropic, and with a tem- 
perature under double tents of 49 to 49 1-2° of Reaumur. Ima- 
gine to what a distillation we were subjected 1 By Heavens ! 
I sweated as much in a day as a chemist's laboratory in ten. 

Quaiabseh, taken in a good point of view, is picturesque in 
its way. The two mountain chains, the Arabic and Libyan 
approaching each other, present walls forming a kind of theatre 
of the width of about eighty geometrical paces, or rather a gate- 
way or pass, which the Arabs call Bab-el-Nil, or gate of the 
Nile. The mountains are black, ferruginous obsidian, of dif- 
ferent varieties ; nature harsh and sterile ; the inhabitants 
darkly bronzed ; mostly wretched fishermen, belonging to the 
isles of the internal basin beyond the pass; the women full of 
spirit, less repulsive than the Egyptians, but of the strictest 
chastity. The girls go naked 'till the period of their marriage, 
that is to say with nothing more than a piece of skin tied round 
the waist, which is cut into thongs, like the fly-guard on the 
heads of our oxen, and ornamented with various coloured bark 
and shells. They are never more than a foot and a half long. 
Every age and sex are lovers of song and dance, and accus- 
tomed to them even in their daily labours. Only conceive that 
each little company of labourers of every description has its 
singer and musician, and does nothing without music. I visited 
sixteen other splendid temples, and, especially those of Ebsam- 
boul, excavated, like many others, in the mountain, but more 
beautiful than any of the same description, being ornamented 
with bas reliefs from the floor to the roof of every room. I 
reached Abedunacti and then Abedurgam, the first with its 



&6 Signor Segattts Discovery. ^July, 

eighteen cataracts forming the second. I saw Soda and Amis- 
chientino, on the west bank of the Nile, and ascended the peak 
of Bak-bak, where I found the names of nine European travel- 
lers, among which were two Italians. — I made the third. This 
peak overlooks a great part of the cataract ; a grand but 
gloomy prospect. The Nile shoots its proud roaring waters 
amid a thousand isles of -dark granite, presenting a surface 
shining like glass. Some scattered palm and turpentine trees 
deck this dark solitude, inhabited by a few Berber families, who 
have a like disdain of clothing as -their neighbors, but a more 
agreeable language and greater probity. Here, as I said before, 
I left the expedition. Master of my own movements, I desired 
to form, from personal observation, an accurate idea of the 
desert. Accompanied by my faithful Berber servant, and pro- 
vided with some dried dates, water, and a little bread which 1 
got from the soldiers, I passed on from Abki to Abdon, then 
traversed Colicombo, and ascended the intermediate Troglodyte 
chain dividing Nubia from the great desert of the Abadi, into 
which I penetrated in the direction of East, a quarter South- 
East. Behold me a solitary wanderer amid an ocean of burn- 
ing sand, precisely of the colour of melted metal, bounded only 
by the horizon on all sides, without a sign of vegetable and few 
of animal life, under a daily temperature of 64 to 65 of Reaumur, 
in a desert into which I was the first to penetrate. My dress 
was European, except the hat, which I exchanged for a red cap. 
In the evening when I stopped, my kingdom was all around me ; 
I ate my luxurious supper of dates, bread and water, and 
wrapped up in a woollen coverlet, slept sweetly 'till the morrow, 
without a sound to interrupt my slumbers. My own voice, my 
servant's, and our camels, alone broke the silence of the desert. 
Sometimes we saw Hocks of ostriches, but they fled like light- 
ning. It was the twentieth day before we exchanged a word 
with any human being. It was a wandering horde we met. 
We approaehed each other, we spoke, I gave them some pre- 
sents, they gave me some in return, and we parted. The 
thirty-seventh day we arrived at some miserable huts, the sight 
of which rejoiced me greatly. They wee formed of layers of 
dog's grass, and inhabited by an Aba- Ion chief, two young and 
pretty wives, and two beautiful children. I demanded hos- 
pitality, stammering in their tongue, and it was granted 



1836.J Signor frcrafo's Disco very. 87 

me to an unexpected extent. The master of the house!. 
invited me to sit down in the midst of them : the women 
eyed me from head to foot, with great wonder, but withe 
the least appearance of apprehension. The husband soon 
brought me some dates, and water which, though not good, 
was more delightful to my taste than the most exquisite 
liquor I ever drank. I had a few trinkets and skeins of silk. 
of winch I made presents to the females. This was sufficient 
to establish me in favor. I passed seven days with these kind 
people, who grew fond of me, and treated me with the greatest 
affection. I became much attached to them, regarding and 
behaving to those amiable women as sisters, kissing their chil- 
dren as if they were my own, and envying their felicity. The 
constant tranquillity, cheerfulness and harmony of this rustic 
family, founded on the rigid simplicity of their habits and man- 
ners, presented a contrast, I assure you, shameful to civilization. 

The 45th day, considering my slender stock of provisions, I 
resolved to return towards Abki, where I had left various ef- 
fects. I took leave of my kind hosts, who kissed me a 
thousand times, and commenced my journey. After tweny-two 
days' travel, during which we saw no living thing, and not the 
smallest plant, we fell in with a caravan of slaves going to the 
market of Cairo. I travelled two days, in company with them. 
for the purpose of becoming acquainted with the habits and cus- 
toms of their different tribes, for which the master of the cara- 
van, who spoke Arabic perfectly, gave me every facility. 

The sixtieth day, we encountered two wandering hordes, 
who did not molest us. These people were of tall stature, slen- 
der, very meagre, with fierce looks, eyes full of fire, and very 
little beard. They are tattooed in various parts of their bodies. 
The women especially, who are very lively, trace handsome 
drawings in blue-black upon the belly, under the breasts, and on 
other parts of the person. They stain the gums black, and have 
a spot of the same colour on the lower lip. All the men have 
black hair, curled, and hanging down behind, resembling a long 
w T ig, cut straight across, about two finger's length below the 
shoulders, and always greased, which defends them against the 
heat of the sun. 

They have no riches or ornaments, but a camel or two, (not- 
all of ihem even this) a shield of crocodile or hippopotamus's kin. 



88 Signor Segato's Discovery. [July, 

and a lance, which they manage With extraordinary dexterity. 
They have some peculiar superstitions, and practice circumci- 
sion and excision, which they perform in a barbarous manner 
with great solemnity. I had the good fortune to witness a mar- 
riage, a funeral, and an excision, of which I have preserved a 
minute description, as also of some other curious matters. 
Although I have often found myself jn situations where others 
would have been discouraged, my resolution never forsook me. 
Anxious to penetrate still further, but prevented by the want of 
means, indifferent to heat, hunger, and even thirst, the most 
dreadful of all sufferings. If you knew, my brother, what it is 
to travel on a dromedary, through" the desert, in the months of 
July and August, more than nine hundred miles within the torrid 
zone, for the most part without water, save such as is stagnant 
and stinking, and that hoarded as the most precious of your pos- 
sessions, since the want of it for one day only, were certain death ! 
Oftentimes I thought of the contrast between my situation in 
Italy in the midst of my family and friends, with all the comforts 
and amusements of life around me, in a temperate climate, and 
that of roaming a boundless desert, among naked black savages, 
where the whole of human desires are restricted to one want — 
water, and the daily heat is from 64 to 05 of Reaumur. Yet all 
this is nothing compared with the pleasure of seeing unknown 
places, and collecting interesting facts and recollections, which 
you will one day hear. 

Finally, on the eighth day, I arrived at Oudi-Alfa, thence I 
went to Abki, at the second cataract, and descending Nubia, 
reached Philoe, and Elephantina, where I remained some days. 
From thence I departed for the Thebaid, to visit the magnificent 
tombs of Biban-el-Moluk, etc. The 29th ulto. I arrived at Cairo 
in thccvening,and experienced some moments of the greatest plea- 
sure. At first, when I entered the Coffee- Room, black, ragged, 
and with a long beard, six months old, no one knew me ; my 
good host, however, soon remarked and recognized me, crying 
out Se^ato ! Segato ! I cannot describe to you the salutations, 
the embraces, the demonstrations of joy that on all sides greeted 
my happy return. I can only tell you it was among the happiest 
scenes of my life. I swear to you my tears fell profusely at re- 
ceiving proofs of such sincere affection from persons on whom I 
fcad no peculiar claims." 



1836.] Signor Segato' s Discovery. 89 

It was in the course of these travels that the first' hint of his 
extraordinary discovery occurred to him. In going from Ouadi-. 
Elfa to Wograt, in the province of Sokkot, across the Eastern 
chain, he saw one of those tremendous phenomena, not uncom- 
mon in the deserts, particularly those bordering on the Nile, in 
upper Nubia, a whirl-wind of the desert, or terrene water-spout. 
These terrible meteors sometimes continue in one spot, expan- 
ded in an oblong form, where they touch the earth, thence assu- 
ming that of a perfect cylinder, they reach high into the air, and 
darken it with clouds of sand whirled about in every direction. 
At the point where they touch the desert, so extensive and pro- 
found is the excavation they leave, that it*might be taken for the 
bed of a huge lake. At other times becoming moveable, and in 
all other respects maintaining their ordinary character, they 
fly through the desert, tearing it up in their course to an extent 
in proportion to their width at the base, and leaving behind them 
what resembles the bed of a torrent. 

Segato fell in with the track of one of these progressive whirl- 
winds, and unintimidated by the proximity of so dangerous a 
neighbour, continued to follow the deep ravine it scooped out, 
and to examine the wrecks it made or disinterred. Some frag- 
ments of a carbonized substance, presented themselves to the scru- 
tinizing eye of the philosopher. Subjected to more minute ex- 
amination, he recognized animal remains, and especially those of 
the human species. He at last found an entire body, the flesh 
and bones completely carbonized, the one black as charcoal, the 
other of a sooty hue, and both friable. He plainly perceived in 
this corpse the human figure, though shrunk to a third of its na- 
tural dimensions. That which to another, would have been 
merely an object of barren wonder, became to Segato the first 
hint of his discovery. He brooded upon it for years ; he ex- 
hausted all his science upon various experiments ; often disap- 
pointed, but never disheartened, he continued to interrogate na- 
ture, until wearied as it would seem by his importunity, he has at 
length extorted from her one of her mysteries. In the course of 
his persevering researches, he effected with great labour, an 
entrance into the pyramid of Abu-Sir. Remaining there six 
day?, he contracted from the foul air of the catacombs, a tedious 
and painful malady, which was pronounced incurable, and the 
unfortunate Segato returned to his country, merely, as it was 
12 



90 Signer Segaio's Discover;/. [July- 

believed, to die. After arriving at Leghorn, however, 1 he- 
strength of his constitution triumphed over the disease. He- 
resumed his experiments with fresh ardor. The first public 
notice given of his success, was a very modest one, by the author 
himself, in the Antologia, Vol. 44, No. 132, December, 1831, p. 
74. At that time, he had not acquired the means of petrifying 
animal substances so perfectly as at present ; and in employing" 
the terms petrify and petrifa* tion, he warns his readers that he 
uses them in a new literary sense, to signify an induration, resem* 
bling and approaching that of stone, not a petrifaction in the sci- 
entific sense of the world. 

The process of Segato acts upon entire animals as well as 
upon their separate parts. It endues them with a consistence- 
perfectly stony, which is more or less hard in proportion as the 
parts themselves are originally less soft and mucous. Skin* 
muscles, nerves, veins, tendons, fat, blood, all undergo this 
wonderful change, and what is most singular, is, that it is not 
requisite to extract the viscera or intestines for the purpose of 
effecting it : they themselves assume a like solidity with the 
rest of the body, and some of them even greater. Nor is there 
any material change of form, colour, or general appearance and 
character, all of which are retained. Not the least disagreeable 
smell is emitted from his preparations ; they are entirely inodor- 
ous. Such is the power of the agents he employs, that putre- 
faction already begun, is arrested at the very stage at which it 
had arrived when his process commenced. He has even found 
the means of rendering animal substances inalterable without 
destroying their flexibility. The joints and articulations may 
be bent, and when the force applied is removed they resume 
their former position. His skeletons remain united of themselves* 
by their natural ligaments, retaining their pliability, thus render- 
ing useless all the clumsy contrivances heretofore necessary for 
combining the bones together. So unalterable are the sub- 
stances thus preserved, that they are not only unaffected by 
atmospheric change, but even by a daily exposure to Water, 
aid the action of worms. Their volume is but slightly decreased, 
and their weight continues nearly the same. Even the spots 
upun the skin remain visible, whether natural or produced by 
disease. The hair adheres firmly ; not one drops from the 
human scalp, where they continue fixed as freshly and firmly 



f$3f>.j Signer Segau/s Discovery. 91 

as in life. Birds do not lose a feather, nor fish a fin or scale- 
both preserve their hue. Insects retain every extremity, antenna?, 
and cartilage, however minute. Reptiles, besides their perfect 
preservation, wear so strong an appearance of life, that it is 
-difficult to believe them dead. With many of these animals even 
the eye still glistens, and from their immobility only is their 
death to be discerned. Many entire specimens, either petrified, 
or rendered inalterable, with a consistence less rigid, are to be 
found in Segato's cabinet. A few shall be enumerated which I 
have myself seen and handled. A mouse, with the entrails pro- 
truded, looking as fresh as if it were but that moment prepared. 
A canary bird, one of Segato's earliest specimens, yet retaining 
its life-like appearance. For ten years it has been annually 
exposed to the attacks of water and worms, without the least 
injury. During the first year thirty, in the next more than 
forty days, it was immersed in water to test its incorruptibility. 
For a longer time it was shut up in a box with worms, but 
came out unhurt. Various other specimens have been subjected 
to the same test with uniform success. A parrot, in excellent 
-preservation. The frog in every state, from the egg to the 
perfect animal, and thence through different stages of decompo- 
sition to the skeleton. The land tortoise (Tertudo Greca, Linn.) 
in every stage. Numerous spiders apparently retaining the 
agility of life. A water viper, (Coluber natrix, Linn.) a toad, 
(Bufo Viridis, Linn.) and a cameleon, (Lacerta Viridis, Linn.) 
all admirable. In ichthyology there were many fine specimens. 
1 will enumerate only, Tench, Flounders, the scorpoena scropha, 
Jabrus julus, and Lophius piscatorius of Linnaeus, and the tor- 
pedo narke of Riss. 

The anatomical preparations of various parts of the human 
body are exceedingly curious, arms, legs, feet, hands, &c. The 
hand of a female, who died of consumption, in a state of extreme 
emaciation. That of a man, flexible in all the joints. A foot ac- 
tually marble, yet bearing every mark of the skin, even the 
fine circular lines of the heel. On both hands and feet the nails 
adhere perfectly. The intestines of a child of the natural colour 
and form, from which even the fasces had not been extracted. 
The liver of a confirmed drunkard, who died from intemperance, 
brow r n and shining like ebony. The entire human brain pre- 
senting all its convolutions, but of extreme hardness. A female 



92 Signer Segato's Discovery. [July 

bosom, white and full, of the natural appearance, even to the fine 
down of the skin, the roundness of the breasts, and the areola of 
the nipple. A scalp, or hinder part of the head with long fair 
hair, as bright and beautiful as in life. The head of an infant 
subjected to the process, after putrefaction had turned it black, 
and destroyed the eyes, yet by the power of the agent employed, 
saved from farther change. The flesh and skin have become 
hard, the cheeks continue full, the cars, nose, and even the fine 
hair of the head are perfectly preserved, and the brain also, be- 
ing equally indurated. 

Segato has constructed a tablet, composed of different pieces 
of the human body, indurated and inlaid in a tessellated form, 
after the manner of those productions of art which are known in 
Florence, by the name of works in Pictre Dure. It consists of 
214 p eces of various shapes and colours, differently veined, and 
of such hardness that all admit of polish, none are scratched by 
the nail, few by the knife, and some scarcely by the file. The 
Jasper of Siberia is imitated by portions of the spleen, kidneys 
and heart. The Jasper of Sicily, Saxony, and Bohemia, by the 
pancreas, the uterus, the placenta, and the upper part of the 
toague. Almost every variety of siliceous and calcareous stone 
which has been applied to the purposes of use or ornament, 
except only the gems, finds in one portion or other of the human 
body, when thus indurated, either in its healthy or some disor- 
dered state, a singular and striking resemblance. So perfectly 
natural is the colour and appearance of the specimens of morbid 
anatomy thus preserved, that a most distinguished surgeon of 
our country,* who recently visited Segato's cabinet, on being 
shewn this tablet, named immediately various parts of the body, 
and the particular disease with which they had been affected, 
It was impossible, he said, to avoid recognizing them; they 
were exactly such as he had repeatedly seen in dissections. 

Warm and honorable testimony to the importance and 
utility of Segato's discovery, has been borne by several of his 
learned countrymen. His name has already acquired some 
celebrity in Europe, from his admirable maps of Africa, Mo^ 
rocco and Tuscany, prepared and engraved by himself, — for 
among his other talents, he is an excellent chorographcr and 
engraver, — and from a work on Egypt, part only of which has 

*Dr. Mott, of New York. ~— „ - 



183C>.] Signor Segatrfs Discovert/. 9 k A 

yet appeared. Several literary and scientific journals have 
mentioned his labours with the highest commendation. That 
you may not suppose me misled by ignorance or enthusiasm, I 
subjoin some extracts from communications on the subject of 
Segato's discovery, premising only that they are written by 
some of the most eminent anatomists and surgeons of Italy. 

In July, 1833, Dr. P. Betti, at that time Professor of human 
and comparative anatomy, and of practical surgery, in the Im- 
perial and Royal chief Hospital of Santa Maria nuova in 
Florence, says, " I have seen and examined, at different periods, 
various anatomical preparations dissected by the eminent 
Giromalo Segato, and preserved by him according to a parti- 
cular method of his own invention, in which the neatness of the 
preparation and the durability of the subject preserved, were 
carried to so high an extent, as to leave nothing farther to be 
desired in either of these particulars, for which reason I believe 
the method employed by Signor Segato is by far more perfect 
than any yet known and used." 

In April, 1835, Dr. Antonio Targioni Toretti, a member of 
the Medical College of Florence, Professor of practical chemistry 
in the Royal and Imperial Academy of Arts, and of botany and 
materia medica in the Imperial and Royal chief Hospital of 
Santa Maria nuova of Florence, declares, that " having atten- 
tively examined and observed the different anatomical and 
anatomico-pathological preparations, made by Signor Giromalo 
Segato, as well as others in comparative anatomy, and various 
fish, reptiles, insects, and other animals prepared for collections 
of natural history, I am enabled to assert : That besides the 
high degree of anatomical knowledge, and great skill in prepa- 
ration exhibited by him, he has discovered a method heretofore 
unknown, and altogether peculiar to himself, by means of which 
bodies and parts of animals are preserved, maintaining their 
natural colour, and exhibiting all the peculiar appearances inci- 
dent to certain pathological conditions. Besides this, they 
acquire a hardness which may be called stony, since they 
are not scratched without difficulty, and they resist the action 
of the air, of humidity and of worms, so that they may be con- 
sidered absolutely inalterable and incorruptible. Over and 
above this invaluable property of incorruptibility, is that pos- 
sessed by his preparations for exhibiting the natural form and 



$4 Signer Segato's Discovery. L.TuIy, 

colour, so that the most delicate specimens of anatomy seem 
freshly made, such is their truth and nature. I therefore be- 
lieve that the method practised by Signor Segato will be of 
infinite advantage to science, as well for collections of human, 
comparative, and pathological anatomy, as for those of natural 
history and zoology, and therefore worthy of all praise and 
encouragement." 

In April, 1835, Dr. P. Ferdinando Zanetti, Professor of Ana- 
tomy in the Iloyal chief Hospital of Santa Maria nuova of 
Florence, states, that having already, in June, 1833. given to 
the distinguished Giromalo Segato an attestation of his excellent 
mode of preserving organized animal substances, he feels it a 
duty, at present, in consequence of more recent and. repeated 
inspections of preparations since made by Signor Segato accor- 
ding to the same method, to certify the great utility of his dis- 
covery, as well for the perfect preservation of the form, and the 
identity of colour and lustre, as for the great solidity imparted, 
securing to his specimens, with the most entire certainty, an 
indefinite duration ; and this as well in reference to separate 
pieces and organs, as to entire animals, whether reptiles, fish, 
er others of more complicated formation." 

In May, 1835, Dr. Betti, before mentioned, then become 
Professor of Physiology, and Superintendent of the Public Hos- 
pitals of Florence, attests, " that he has examined various spe- 
cimens of parts of men and animals solidified by Signor Giro- 
iumIo Segato, to such a degree as to assume a stony hardness, 
similar to that of the finer marbles, and pietre dure : and more- 
over, that Segato in his presence tried the experiment of filing 
with an English file various specimens of marbles and other 
hard stones, and with the same file his own preparations, the 
latter not being touched by the file, which had more or less 
scratched, or taken off, portions of the former. The hardest 
pieces were — muscle — coats of the intestines and bladder — 
liver — placenta — testicles — arteries — veins and the blood itself.' 7 

It is well known even to those little versed in such studies, 
that Nature has at all times exhibited specimens of animal and 
vegetable petrifactions. Petrified branches and roots of trees 
and shrubs, and pieces of the trunk half of wood and half of 
agate or other stone, are not uncommon. Walnuts, pine cones, 
and even peaches and melons, it is supposed, have been petrj^ 



1S38.] Signer Segaio's Discovery. 6!) 

fied, though the latter are believed by eminent naturalists to be 
only stones accidentally formed into the resemblance of fruit, as 
the lapides Judaici of Mount Carmel are not olives, but a 
species of marine shell fish. It is scarcely requisite to mention 
the innumerable marine petrifactions, madrepores, corals, nau- 
tilii, &c. found in almost every part of the world. Germany 
and Switzerland abound in petrified fish. The Tyrol and cen- 
tral Italy are rich in fossil remains, some of them extinct species. 
In Asia, Africa, and Europe, as well as in America, huge bones 
of various animals have been discovered. In Tuscany, those 
of the Elephant, Rhinoceros, Mastodon, Tapir, Hippopotamus t 
and others, have been found. In various caverns of France, 
England, Germany and Hungary, those of bears, wolves, dogs, 
foxes, hyenas, tigers and lions. The petrified remains of birds 
are much more rare, but these too are said to exist. Fossil 
bones of the human species are the rarest of any, yet the petri- 
fied skeleton of a savage was found in digging the foundations 
of the city of Quebec, two human skeletons by Rosenmuller in 
the grotto of Geiss-knok, and one in the rocks of Guadeloupe 
verified by Cuvier. 

Nature, however, does not seem to have any where presented 
the petrifaction of the entire human body, more especially not 
of the softer and intestinal parts, nor of the blood. The tales 
of a petrified man said to have been found at Aix in Provence, 
in 1583, of those alleged to have been found in Switzerland — 
of the pretended city of Bidollo in Africa, and village of Rassem 
in Barca, whose inhabitants with their cattle and utensils are 
said to have been turned into stone, are all certainly fabulous. 
A very few well attested instances of extraordinary natural 
preservations of the human body have occurred ; as that of 
Cristoforo Landino, one of the commentators on Dante, still 
shewn in Casentino, (Tuscany) turned into a mummy, and un- 
corrupted after the lapse of nearly five centuries. In the ceme- 
tery of Venzone in the department of Passeriana, there is found 
a narrow calcaro-siliceous stratum, in which dead bodies are 
preserved for ages, but only superficially, for ail the internal 
parts turn into dust. It is remarkable thnt the bodies interred 
partly in this peculiar stratum, and partly in that above, or 
below it, are partially preserved, and partially putrify- 



96 Signor Segato's Discovery. [July* 

There are obvious reasons why the natural petrifaction or 
flesh should be much rarer than that of bones, in the different 
properties of the two substances. The latter being calcareous, 
have a greater analogy with the earths, winch replace them 
particle by particle as they decay, while the former is so soft, 
that it does not give time for the stony matter to insinuate 
itself and form, before putrefaction commences. 

Art has not heretofore succeeded better than nature. The 
Egyptian mummies — the embalming heretofore practised — the 
method of Ruyschius (unfortunately lost) — the mummies made 
by Chaillot, Capron and Boniface, much talked of in France — 
the preservations effected by Chaussier, 'and reproduced by Dr s. 
Tranchlna and Giovacchino Komco — the sepulchres of Sicily, 
where bodies divested of the intestines and fluids are kept dry 
for many years, all attest the wonderful ingenuity of man. 
None of them however it must be confessed have arrived at 
that degree of perfection evidenced in the discovery of Segato. 
From an article obligingly communicated by the distinguished 
Dr. Passed it appears, that being made acquainted with the 
Creosoto*' discovered by Reichembach, and reflecting on its 
chemical properties, it occurred to him, that it might be employ- 
ed to render animal substances solid and inalterable. He men- 
tioned this idea to several, and his wish to try the experiment. 
Nor does his idea seem entirely unfounded, for about fifteen or 
sixteen mouths since, the eminent chemist Signore Gaetan© 
Caramcsi having prepared an aqueous solution of Creosoto 
placed in it a human finger and a small bird. Three days 
afterwards they were exposed to the air to dry. They in fact 
became hard, but as to their incorruptibility, though it might in 
some degree be inferred from their solidity, it would not be 
proper to affirm it, as they have not been exposed to the test of 
humidity or worms, nor as yet, of sufficient time. Besides, 
they had contracted a dusky colour by reason of the action of 
the creosote, which becomes dark when exposed to the light. 
These specimens are now in the hands of Scgato. 

The ingenious Signore Carraresi imagined and tried another 
experiment, He deprived some small pieces of animals of 

*The Creosoto is a volatile oil contained in the Norwegian pitch, and is 
produced along with smoke whenever vegetables are burned, li was dis- 
covered not long- since by Reichenbach, and its most remarkable property 
is that of preserving animal substances. W. 



1836.] Skgnor Segato's Discover]/. 97 

their aqueous particles, by means of pure alcohol saturated 
with boracic acid, and that being effected, for the purpose of 
solidifying the albumine, so that it might be secure from putre- 
faction, he immersed it in the same alcohol, in a boiling state. 
Subsequently exposed to the air, and dried, they became solid, so 
as to be susceptible of some degree of polish. It must be admit- 
ted, however, that these preparations are very far from the per- 
fection of Segato's, as well with respect to colour as solidity. 
Besides which, his having for ten years resisted the attacks of 
moisture and worms, precludes all possibility of comparison 
between them and pieces recently prepared. I have not seen 
the specimens of indurated heart and blood, mentioned in an 
anonymous article inserted in several Italian Journals, said to 
have been prepared by Dr. Mori, of Piza, and of course have 
nothing to remark upon them. I suspect, however, that the 
observations of Dr. Passeri upon the experiments of Carraresi, 
will be found equally applicable to those of Tranchini and Mori 
also. 

Florence, 10th January, 1836. 

[It is now our painful duty to announce, on the authority of 
.letters of a later date, from Mr. Wilde to his brother, the Hon. 
John W. Wilde, the death of Signor Giromalo Segato. This 
is an event greatly to be deplored. There was a lively hope 
that Mr. Wilde would be enabled to induce him to come to the 
United States ; where his genius, scientific attainments, and un- 
tiring perseverance might have spread an influence around, the 
value of which to this.country no one could estimate. With re- 
gard to the process by which he effected those wonderful preser- 
vations above described, it is greatly to be feared the world will 
never be informed; for, at the date of the last communication 
Jrom Mr. Wilde, no account of it had been found. — Ed.] 



1Z 



i)S C nimilkier s Pathological .Anatomy, <fc.- [July 



Part II.— REVIEWS AND EXTRACTS. 

Cruveilkiers Pathological Anatomy. Second edition of AliberCx 
large treatise on, Cutaneous diseases. Bmirgcry's Anatomy. 

Our medical college has just received a number of highly 
interesting and valuable works from Europe, many of which, 
from their high price, are unfortunately excluded from the 
private libraries of the great majority of the profession. We 
rejoice that we have amongst us an institution through the in- 
fluence of which we are permitted to have access to the publi- 
cations of our transatlantic brethren, however costly they may 
be. This privilege is peculiarly valuable at the present period 
of medical science, inasmuch as most of the improvements are 
promulgated in foreign languages, and cannot therefore be re- 
published without the slow and often inaccurate process of 
translation. Indeed, many of the most useful works in medi- 
cine have never been translated, and will probably never be 
extensively known in our country, except through the medium 
of periodicals. 

Among the works received, are the two last fasciculi of Cru- 
veilhier's pathological anatomy. One of these completes the- 
first volume, and the other commences the second. The plates 
are, as usual, of the most perfect finish, and a real treasure to 
those whose opportunities of post-mortem examinations are 
limited. These numbers are rich in specimens of affections >f 
the bones, of the brain, of the stomach, and of the heart. M. 
Cruveilhier having assigned no limits to his work, will, we 
trust, continue with his accustomed judgment and zeal, thus to 
treasure up the interesting cases which are continually pre- 
sented to him at the Salpetriere, and at the Societe Anatomique. 

The second edition of Alibert's large treatise on cutaneous 
diseases, is at last completed. The. fasciculus just leceivcd 
fully sustains the great superiority which has been claimed for 
this over the former edition. The plates are incomparably 
more perfect, many of the specimens better selected, and their 
number greater than in the old work. It is much to be regret- 
ted that such a work cannot be in the hands of all practitioners. 
There is perhaps no class of diseases less generally understood 
than that of which Alibert so ably treats. The reason is that 
they are difficult to describe, and require to be seen to be un- 
derstood. Alibert, in reprinting and improving his plates, has 
therefore rendered a signal service to the profession, by placing 
before the reader correct representations of every variety he 
describes. 



JS3(>.] C ruveff /tiers Pathological Anatomy ', <$-c. i)§ 

An >incr work received is Bourgery's Anatomy, with plates. 
It is the most extensive publication ever undertaken on any 
branch of medicine, and has, we believe, never been surpassed 
in magnificence and correctness. We hope that, notwithstand- 
ing the heavy cost of the entire work, the mode adopted for its 
publication will enable many to subscribe to it without serious 
inconvenience. The following is an extract from the prospectus 
handed us by Dr. L. A. Dugas, of this place, who is authorized 
to receive subscriptions. 

This great system of anatomy, then, will be comprised in eight volumes. 
folio, and be embellished with from four hundred and fifty to five hundred 
lithographic plates. It will consist of four parts : — Descriptive anatomy ; 
Surgical anatomy.; General anatomy ; and Philosophic anatomy. 

The descriptive anatomy will be presented with all its details, and with 
its physiological and pathological applications. This division will consist 
of five volumes r the first containing osteology and syndesmology ; the 
-second, myology, the aponeuroses, and the synovial bursas ; the third, the 
nervous system, the organs of sense, and the larynx ; the fourth, the 
apparatuses of circulation and of respiration ; the fifth, the digestive and 
generative organs, and the anatomy of the foetus, or embryotomy. 

The surgical anatomy will be composed of three sections, comprised in 
the °ixth and seventh volumes. The first section, or anatomy of inter-or- 
ganic isolation, will show the organs apart from the ensemble, and some of 
their diseases circumscribed mechanically and fixed in the interior of the 
aponeurotic cells and bony confines of" the viceral cavities. The second 
lection, or anatomy of inter-organic communication, on the other hand, will 
exhibit the means of connexion between the organs, the pathological effect 
of which is to facilitate the development and extension of disease. The 
third section will present the anatomy of every important region of the 
body in reference to the various operations of surgery, the whole of which, 
and the different instruments, employed, will for the first time be system- 
atically represented in the plates, and described in the text. Statistical 
corollaries, deduced from results obtamed in an immense number of opera- 
tions performed in different countries, under the most varied circumstances 
it various epochs, will show the relative value of each plan of operation 
pi; j-osed. 

The general anatomy will present the study of every tissue under two 
points of view, which form the connexion between histology, properly so 
!, and pathology: — 1st, as a whole, as one of the separate systems of 
thy economy; second, as a part, in reference to the various places in which it 
'is found, and as an integral item in the constitution of any particular organ 
jdi- srstL-m of organs. 

The philosophic anatomy will contain three sections : — first, the laws of 
the formation of the organism or economy, depending on which are the theories 
of the vertebra and of monstrosity ; second, the influence of physical and moral 
causes on the economy; third, the comparison of the economy of man with that 
of Tic vertebrate animals; — subjects extremely interesting not only to the 

MEDICAL MAN, but to the MORALIST, the PHILOSOPHER, the LEGISLATOR, and 

the political economist. The general and philosophic anatomy, together, 
will form the eighth and last volume of the work. 

The translation into English, now offered to the public, has been called 
for by a number of subscribers to the work both in Great Britain and Amer- 
ica. Undertaken by a gentleman familiar with the subject, and from a 
copy with the latest corrections of the author, it is presumed that it will be 
found in nowise inferior to the French edition. The plates for both the 
'English and French editions are the same. 



100 Tartar Emetic in Obstetric Practice. [July, 

The complete work, as has been sai£, will consist of eight volumes, folio, 
and will appear in about fifty monthly parts, eacli containing from three t<* 
four sheets of test, and eight lithographic plates,, with their explanations. 

PRICE OF EACH NUMBER. 

IN FRENCH. 

The Plates uncoloured, on fine Vellum Paper,. - 8 francs, 

do. do on China Paper, - - - 12 • « 

The Plates on fine Vellum Paper, coloured with the greatest care, 16 " 

IN ENGLISH. 

The Plates uncoloured, on fine Vellum Paper, - - - 10 shilling^ 

do. do. on China Paper, - , - - - 14 " 

The Plates on fine Vellum Paper, coloured with the great- ) ,g 

est care, \ 

N. B. — The publication has reached the middle of the third volume,. 



[From the Medical Journal of Medical Science.] 

Observations on the use of Tartar Emetic in Obstetric Practice. By Evory 
• Kennedy, M. D. Master of the Lying-in Hospital, Dublin. 

[CONTINUED FROM JUNE NO.] 

Obstructed and Inflamed Mammae-. — There .are two distinct states of 
the mammae, occurring after delivery, which demand our notice. lit 
both, pain and tenderness, tumefaction and hardness, are present ; 
but one is an inflammation, the other merely an obstructed state of 
the organ j though the latter generally precedes, and may produce 
the former, yet it does not necessarily go in all cases. There is no case 
within the range of obstetric practice so clearly under the control of 
the medical attendant, as the tumified, lobulated and obstructed state of the 
mamma?, and none so sure to terminate unfavourably, if improperly managed. 
To treat it with effect, it is necessary to look to its cause. The immediate 
state is a vascular determination to the glandules, together witli an accu- 
mulation of the lacteal secretion within the ducts and tubes, and often in- 
filtration into the connecting cellular tissue ; a state most frequently arising 
from a disproportionate action between the secretories and excretories. We 
can easily understand the frequency of the occurrence of this state of the 
br fasts, when we consider how suddenly in most cases determination 
occurs to them after delivery. Let us, then, bear in mind the function the 
glandular part of the organ is so suddenly called upon to assume, and this, 
perhaps, for the first time : thus rapidly converting the freely determined 
blood into a nutritive fluid. Let us also call to mind the obstacles afforded 
to the escape and extraction of the milk in impervious, ill-formed, or dis- 
eased nipples, as well as the difficulty that opposes itself tp the transmission 
of milk through ducts, perhaps for the first time ; or after a long suspension 
of their action, called upon to perform the office of conduits ior thSe new 



183&] Tartar Emetic in Obstetric FrachcK 101 

and rapidly formed secretion. These considerations tend to explain a fact 
observed in practice, that, with first children, or after long- intervals from 
child-bearing-, more trouble is experienced with the breasts, on delivery. 
When, in addition to what has preceded, we recollect the varying calibre 
of the conduits, their ramifications, and the accidental obstacles occurring 
in them, the effect either of present or previous disease, narrowing them, or 
perhaps rendering them altogether impervious, and amongst the most com- 
mon of these, determination to certain parts of the orga^i, from exposure to 
cold, we need not wonder at trouble being so frequently caused by the 
breasts, after delivery, but rather feel astonished that milk abscess is so 
rare an occurrence. The rationale of the plan of treatment necessary to 
adopt will appear from what has preceded, to be, simply, checking or pre- 
venting too rapid a determination to the breasts, and relieving the ducts 
and tubes by facilitating the transit and escape of the milk when secreted. 
In effecting the first object, free saline purgation is necessary in the com- 
mencement, after which nauseating doses of tartar emetic appear to act 
almost as a specific in preventing inordinate determination. They also, no 
doubt, act m producing absorption. Tartar emetic, however, appears to 
eft*'ct the second object as well as the first, by its well-known power of 
relaxing contractile tissues, thus rendering pervious the lactiferous ducts 
and tubes, and accomplishing the double object specified. It is not to be 
understood that tartar emetic has been had recourse to in all cases where 
the breasts were hard and full after delivery, nor even that this medicine 
would prove sufficient of itself to correct their obstructed state. The 
general plan wis to administer saline aperients, rub the breasts mosl 
assiduously, stupe them, extract the milk from them, if necessary, and im- 
prove the state of the nipples, if they were diseased or indented. In the 
freat proportion of cases, this is quite sufficient to produce softening of the 
reasts with free discharge of the milk. It is only when this plan don't 
succeed, or that symptoms are urgent, that it is deemed necessary to 
nauseate the patient. The result of this practice is, that in the Lying-in 
Hospital, where it is strictly enforced, a case of abscess in the breast is 
scarcely ever met with. It is but right to state, that in private I have not 
found the practice succeed so well; a circumstance ascribable simply to 
the impossibility of having the necessary directions strictly and effectually 
complied with. Ladies get fatigued with continued friction, and they do 
not like the nauseating medicine. Where it has been fairly tried, however, 
its results have been the same as in Hospital. Friction, to be attended 
with benefit, must scarcely for an hour be desisted from, until the hardness 
disappears and the ducts accommodate themselves to the secretions. The 
usual orders to our nurses are, " to rub until the breast softens under the 
hand." Warm oil is used to prevent irritation to the integument from the 
friction. In inflammation attacking the breasts after delivery, either the 
glandular or tubal structure, the investing sheath, or the connecting or sur- 
rounding cellular tissue may be engaged in the inflammatory action from 
the commencement, or the inflammation may occur consecutive upon the 
state of the breast already described. In either case, throbbing pain, 
general redness of the surface, with extreme tenderness to the touch, and 
hardness at one part, will be present ; and these symptoms may be ushered 
in with a rigor, or rigors may occur in their progress. When this attack 
is observed, the patient is to be put immediately and freely under the influ- 
ence of the tartar emetic. If purgation has not been previously attended 
to, a grain of tartar emetic, given in a full dose of black bottle, is a good 
commencement. This should be speedily followed by the nauseating mix- 
ture, and if vomiting should be twice or thrice freely produced at the outset, 
all the better, provided our patient can bear it. Warm stuping and fomen- 
tations must be used, and the breasts drawn by a strong healthy child, or 
by the exhausted bottle, and friction, if unattended with much pain, is to be 
persisted in.. Leeches, under this plan of treatment, are seldom necessary » 



itr u :2 ^Tartar Emetic in Ob&telric Practice. [July. 

arid their efficacy, when used, appears very questionable. By a steady 
persevererice in this plan, in cases even the most unpromising-, the inflam- 
mation has been again and again subdued. 

The child was generally applied to the breast early after delivery, at 
least as soon as milk could be obtained. Ulcerated and fissured nippies, 
which did not improve under slight stimulating lotions, as Sir A. Cooper's 
spirit and borax wash, were touched with a solution of nitrate of silver, ten 
or twenty grains to the ounce, a plan found particularly serviceable where 
there were sprouting granulations or excrescences projecting in the fissure, 
alto acted with excruciating pain. In obstinate cases of this kind, even 
touching with solid caustic was necessary, and often relieved the patient 
from immense protracted suffering. 

Puerperal Mania. — This form, which constitutes so great a proportion of 
the maniacal cases met with not merely in the Hospitals for insane, but 
in the incurable cells, when treated properly from the commencement of 
the attack, is a very manageable disease. Were it only for its efficacy in 
this distressing malady, the accoucheur should esteem tartar emetic as a 
most invaluable article in his prescription formulary. In several years 
observance of this medicine's application, in Hospital and private practice, 
but two or three cases have been met with which held out against it, when 
commenced sufficiently early. The moment a patient was observed to 
exhibit any incoherence after delivery, attended, as it usually is, with rapid 
pulse and wild expression of the eye, she was placed under its nauseating 
influence, and retained so- for twenty- lour or thirty-six hours, or longer if 
necessary. In almost every case the disease yielded immediately ; the 
real ills produced by the medicine taking the place of the imaginary ones 
previously occupying her attention. The only treatment in general 
necessary, in addition to this, being the administration of aperients, and 
ensuring sleep by free opiates, when the patient had been sufficiently sub-, 
jeefced to the action of the tartar emetic. Diagnosis in puerperal mania 
requires attention. The case most likely to be mistaken for it, is hysteria ; 
an affection of no very Uncommon occurrence after delivery. An error in 
diagnosis, between these diseases, is not, however, attended with any very 
serious inconvenience in the treatment, as I have found from experience 
the plan here recommended for puerperal mania proves most effectual in 
curing hysteria ; although it is perhaps, somewhat more violent than the 
nature of the case demands. It may be right to mention that two fatal 
cases of peritonitis occurred in Hospital, which commenced witli all the 
symptoms of puerperal mania, and Which were treated at first with tartar 
emetic. In one case, in the course of a few hours from the exhibition of 
the maniacal, symptoms ; in the other, after a lapse of two days from their 
commencement, unequivocal -evidences of peritonitis set in, and in both the 
disease ran rapidly to its fatal termination. A peritonitic tendency was 
very r revalent at. the time. In puerperal mania peculiar care is necessary 
to prevent the depressing effects of tartar emetic being produced, and with 
this view a larger quantity of laudanum may be added to the nauseating 
mixture. Patients labouring under this disease, are not able to bear the 
same aetive treatment as some of the other cases alluded to where this 
in. ine has proved efficacious. The pulse in puerperal mania, whilst it is 
very rapid, is generally small and hard, often wiry, and here a medicine 
possessing such depresting propensities, must be used with the greatest 
^caution. A case occurred to me in consultation with Dr. Harvey, of this 
city, some years since, strongly illustrating the necessity of caution in this 
respect. We had placed our patient under the influence of the medicine, 
with the usual directions to her friends of administering or withholding it- 
as might be necessary. These, however, were unattended to, and on our 
n< • risit we found her in a most alarming state. The medicine having 
reduced her to such a degree of debility as to deprive her of the power c* 



.1836.] British Association. 103 

motion, her pulse was barely perceptible, and the extremities and surface 
quite cold. Stimulants were freely administered, and friction and warm 
applications used to the surface and extremities, and she immediately 
recovered, not merely from the remedy, but from the original disease. 

In concluding' this paper, it may be mentioned, that it is not swelled out 
with cases, (an abundance of which could have been furnished;) as it is : 
neither wished to extend it unnecessarily, nor to put forward trie practice 
recommended as that tried experimentally in a few eases, but as the ordi- 
nary plan of practice adopted, as well in private as in an Institution con- 
taining one hundred and forty beds, and where about two thousand fiv'3 
hundred patients are annually admitted. As much of it was adopted by my 
predecessor in office, Dr. Collins, an opportunity will shortly be afforded of 
testing its success, and observing the proportion of recoveries in these 
cases^recorded in that .gentleman's, report of his seven years' mastership., 
shortly to be published ; and it is confidently anticipated that in this report 
will be exhibited a degree of success, not merely m the cases treated of, 
but in midwifery practice generally, never before recorded. I ventured to 
publish an expression of my opinion of Dr. Collins' talented, accurate, and 
laborious undertaking two years since, how far correctly, the%*ecent vote 
of hanks presented by the Anatomical Section of the British Asso • 
him, fbr this very report, has proved. 

Dublin, 8eplember 9 1835. 



Extracts from that part of the proceedings' of the Medical 
Section of the British Association in the session of August, 
1835, which is detailed in the Medico-Chiriirgical Review for 
October last. 

First Day, 10th August. Internal use of Chloride of Sodium in Fever. 

Dr. B. Graves read an interesting paper on the internal use of chloride 
of sodium in fever, from which we make the following extract, as embodying 
the pith of the practical portion of the communication. 

" With respect (said Dr. G.) to the time for its exhibition, and the cases 
to which it is adapted, the following remarks may be made. When the 
early stage of fever is past, when all general and local indications have been 
fulfilled, when there is no complication with local disease, when the patienf 
lies sunk and prostrated, when restlessness, low delirium, and more or les.- 
derangement of sensibility is present, when the body is covered with 
macula?, and when the secretions from the skin and mucous membranes give 
evidence of a depraved state of the fluids, it is then that the chloride of 
sodium may be prescribed with the most decided advantage. The mode 
in which I prescribe; it is in doses of from fifteen to twenty drops every 
fourth hour, in an ounce of water or camphor mixture. How it acts I will 
not attempt to explain ; it is sufficient to say, that there is no remedy from 
which, in such cases, such unequivocal benefit is derived. It operates 
energetically, though not veryrapidly, in controlling many of those symptoms 
vrhich create most alarm. It seems to counteract the tendency to tympan- 



104 British Association. L^tyi 

itip, to correct the fetor of the excretion?, to prevent collapse, to promote a 
return to a healthy state of the functions of the skin, bowels, and kidneys ; 
in fact, it appears admirably calculated to meet most of the bad effects of 
low putrid fever. To these who have witnessed its efficacy, it is unneces- 
sary for me to say any thing. Of course it will fail, like all other remedies, 
when the disease has reached a certain point of intensity hi individual cases. 
There is scarcely any acute disease, to which the human body is liable, 
which may not in some particular persons assume an intensity capable of 
baffling ail the efibrts of medical skill. This, however, is no argument 
against the employment of a remedy of extensive utility and unquestionable 
value. 

Although it is not my intention to give an account of what has been don© 
in France with respect to the exhibition of this remedy, yet I may mention 
that it has been extensively tried in fever by Chomel, and as I have learn- 
ed with great success. This excellent physician is still, I believe engaged 
in making further clinical experiments on the subject. In the Gazette Me- 
dicate de Pari?, published on the 28ii of last February, we have an accoi.it 
of Dr. Dor, of Marseilles, of several cases of typhus, in which the chloride 
of sodium was found beneficial in 18-33. He attributes a more rapid amend- 
ment to the use of tins remedy than I have even seen follow from its exhi- 
bition, and he also asserts, that if not given with great caution, it produces 
a very tedious convalescence. In the latter remark, especially, I cannot 
concur ; for all who witnessed this mode of treatment here, were struck 
with the security and quickness of recovery which ensued in those cases 
where it had been employed. Perhaps, the precaution we adopted of al- 
ways diminishing, as soon as possible, the strength and frequency of the 
doses, rendered the results in our hands more satisfactory than those ob- 
tained by Dr. Dor." 

Dr. Graves concluded his observations by reading a letter from his col- 
league Dr. William Stokes, in which the use of this remedy is stated to 
have been followed by the most satisfactory results. It gradually but stea- 
dily removed all the bad symptoms, and in -ill cases the patients had most 
favourable convalescences. Dr. Stokes remarks, that all these cases re- 
covered without any evident crisis. 

Second day, 11th August. Motion and Sounds of the Heart. 

The motions and sounds of the heart occupied the whole of this sitting. 
A committee had been appointed to experiment on this subject, and having 
made their experiments and drawn up their report, they presented them 
to the meeting. We cannot notice all, or many of the experiments per- 
formed by the committee, but only one or two to elucidate the inquiry. 

Experiments on the motions of the Heart. 

" Experiment 1. A calf, two days old, having been secured on its back, 
and prepared as above described, the sternum and a portion of the ribs on 
both sides were removed, when the following motions were observed. The 
heart was beating strongly, at the rate of one hundred and forty-four 
pulsations in the minute, but in a short time fell to eighty. While still 
enclosed in the pericardium, the heart was observed to have a slight vibra- 
tory motion on its longitudinal axis, which motion, it may here be remarked, 
may assist in explaining the phenomenon of frottement in disease. On 
cutting open the pericardium, and turning it aside, both the auricular ap- 
pendices were seen to project with a rapid motion upwards, or towards the 
place of the sternum, and immediately afterwards to recede. When coming 
forwards, they were swollen and soft to the touch ; when receding they 
became hard to the touch, were diminished in size, and flattened. Imme- 
diate! v after the recession of the auric idar appendices, the ventricles with 



1836k J British Association. 105 

a rapid motion assumed a somewhat globular form in their middle^ part, which 
projected towards the sternum, and the apex at the same time was 
pushed considerably in the same direction. During their continuance in 
this state, the ventricles were hard to the touch, and if grasped by the hand, 
at the commencement of the movement, they communicated a shock or 
impulse, and separated the fingers. When the ventricles had remained for 
a short time in the state just described, they suddenly sank downwards or 
towards tire- spine, and became elongated, broad and flat, and soft to the 
touch. 

This succession of motions having been observed for some time, a small 
glass tube was introduced through a puncture into the left auricular appen- 
dix, and the blood was seen to rise in the tube during the recession of the 
appendix, and to subside during its upward movement. A similar tube was 
introduced through a puncture in the right ventricle, and a jet of dark- 
coloured blood was thrown forth during the globular and hardened state of 
the ventricles, and subsided when these became flattened and soft. A 
puncture was made in the pulmonary artery, close to the ventricle from 
which it arises, and through it a stream of blood issued synchronously with 
the jet from the tube in the right ventricle. A tube having been introduced 
through a puncture in the left ventricle, -and one of the mesenteric arteries 
having been exposed and opened, the jet from the ventricles was observed 
to .recede the jet from the arteries, by an interval easily appreciable. The 
femoral artery was opened, and a similar observation was made as to the 
interval between the jet from the left ventricle and the jet from that 
artery. Previously to opening the chest, the committee had satisfied them- 
selves, that the beat of the hearty felt through the sternum and cartilages 
of the ribs, preceded the pulse, felt in arteries at different distances from 
the heart by intervals of time which were proportioned to those distances : 
and they were also satisfied, that the jets of blood from the mesenteric and 
femoral arteries were synchronous with the pulses felt in those arteries. 

Experiment 2. In a calf, prepared as the former had been, and placed 
on its right side, a portion of the ribs on the left side was removed, the 
sternum and part of the cartilages on that side being left in their natural 
position, and the pericardium was opened. It was now seen that when the 
ventricles assumed their hardened state, their apex, and a considerable 
portion of their anterior surface were closely applied to the sternum, and 
wiien the hand was interposed between the latter and the surface of the 
ventricles, a strong compression was exercised on the fingers, during each 
approach of the ventricles to the front of the chest. When the ventricles 
were in their softened state, their interior surface, by which is meant the 
one corresponding to that called anterior in the human heart, was some- 
times in contact with the sternum, and sometimes removed to a little dis- 
tance from it, and from the contemplation of this, and the preceding experi- 
ment, the committee were satisfied that the situation of the heart in the 
thorax is affected by the position of the body, as has been observed by 
others ; for instance, that in the recumbent state, on the back, the heart 
recedes somewhat from the sternum : if the individual lie upon the face, the 
anterior surface of the ventricles is in constant apposition with the front of 
the chest, the pericardium of course being interposed. The yielding- 
texture of the lungs, and the mode of attachment of the pericardium and 
the great vessels, are such, as to allow the gravitation of the heart to 
influence its position in different postures of the body. These experiments 
were repeated on different subjects, and the observations recorded above 
were confirmed." 

For the experiments on the sounds of the heart, we must refer to the 
Dublin Journal, contenting ourselves with the conclusions to wliich the com- 
mittee came from the said experiments. 

"From the experiments on the sounds of the heart, it appears to follow : 
1 . That the sounds are not produced bv the contact of the ventricles with 
14 



±0t> British Association. \S\3bf 9 

the sternum or ribs, but are caused by motions witliin the heart and its ves- 
sels. 2. That the sternum and front of the thorax, by their contact with 
the ventricles, increase the audibleness of the sounds. 3* That the first 
sound is connected with the ventricular systole, and coincides with it in du- 
ration. 4. That the cause of the first sound is one which begins and ends; 
with the ventricular systole, and is in constant operation during the contin- 
uance of that systole. 5. That it does not depend on the closing of the 
auriculo-ventricular valves at the commencement of the systole, because 
such movement of the valves takes place only at the commencement of the 
systole, and is of much shorter duration than the systole. 6. That it is not 
produced by the friction of the internal surfaces of the ventricles against 
each other, as such friction cannot exist until the blood has been expelled 
from the ventricles, whereas the first sound commences with the beginning 
of the ventricular systole. 7. That it is produced either by the rapid pas- 
sage of the blood over the irregular internal surfaces of the ventricles on its 
way towards the mouths of the arteries, or by the bruit musculairc of the 
ventricles, or probably by both these causes. 8. That the second sound 
coincides with the termination of the ventricular systole, and requires for its 
production the integrity of the semilunar valves of the aorta and pulmonary 
artery, and seems to be caused by the sudden check given by the action of 
these valves to the motion of the columns of blood driven towards the heart 
after each ventricular systole by the elasticity of the arterial trunks. 

The Committee wish, in concluding this report, to express their opinion, 
that although much light has been thrown on the subject of the Motions and 
Sounds of the Heart, by recent investigations, here and elsewhere, the na- 
ture of the enquiry is such as renders it difficult in many instances to arrive 
at satisfactory conclusions. They also think that the subject, from its im- 
portance, whether in a practical view, or as an object of philosophical in- 
quiry, is deserving of further investigation." 

As might be expected, a long discussion ensued, in which Dr. \ v illiams r 
of London, and Dr. Corrigan, of Dublin, were the most prominent orators. 
Dr. Corrigan candidly confessed that he was wrong in some of his first con- 
clusions, and was convinced that his character would not suffer by this 
avowal. We are sure it will not ; but, on the contrary, be raised by such 
honorable and honest procedure. The thanks of the meeting were voted 
unanimously to Dr. Williams. 

Third Day. Action of the Heart and Pulse. 

Dr. M'Dormell, of Belfast, read a paper this day on the action of the heart 
and pulse. Our author has some claim to antiquity, as well as to "priority,''' 
mi such observations, having commenced as early as 1764," — that is, rather 
more than half a century back. 

" He finds that in lying, sitting, or standing, there are three distinct num- 
bers in the pulse, any one of which being given, the rest may be discovered 
by inference. This variation amounts generally to twelve, fourteen, or six- 
teen beats per minute, as its normal state, and therefore, that all observa- 
tions of the number of the pulse, which have been made without reference 
to +his principle, must be considered as nugatory, unless it be implied that 
the person was in the horizontal 'position when the observation was made. 
This rule for reducing the number of the pulse to a regular standard, applies 
to health, but not precisely to disease ; the effects of posture must be inves- 
tigated separately in each disease. 

The differential pulse appears to be confined to man. It is not observed 
in brutes, probably because from their form, their posture may be considered 
as always horizontal ; but when placed erect, this peculiarity appears also 
in them. 

The variation, in the human species, is at its maximum in tall and feeble 
subjects, particularly in convalescents from typhus ; the minimum is gene- 



1836.] British Association. 10 5 ? 

Tally found in children. These facts lead to the supposition, that this phe- 
nomenon is connected with some hydrostatic law, and not depending entirely 
on vitality. This, however, is merely thrown out as a conjecture, and re- 
quires further investigation. But in whatever manner it may be consid- 
erc d, it is plain that in all attempts to ascertain the effects of remedies, as 
wr H as of natural causes, due allow T ance must be made for these fixed dif- 
ferences produced by posture. What avails it to say that a medicine, or 
venesection, or heat, or cold, or a thousand other natural causes, raise or 
depress the pulse by four, six, or eight beats per minute, when the mere 
-change of posture would raise or depress it twelve, fourteen, or sixteen per 
minute, and this merely in health, for in disease the differential pulse is 
often double this proportion. 

In tracing the connexion between the pulse and respiration in man and 
■quadrupeds, he finds that it ranges in health from four to six pulses for one 
respiration. This he considers a new and material fact ; for if it be esta- 
blished by further observation, that this is a general law, we shall be able 
to infer the pulse from the respiration, and vice versa. This may be of 
advantage in enabling us to ascertain the number of the pulse in ferocious 
animals which we dare not touch, as well as in man during action or pro- 
gression. 

There is a coincidence between the number of pulses and steps in walk- 
ing, at the common rate of progression in man, that is very remarkable and 
iias not been hitherto noticed. His breathings are also singularly propor- 
tioned to his steps, so that it is easy to deduce these numbers from each 
other. But in hard labour or violent muscular exertion, as in running or 
ascending heights, the proportions are greatly altered. The same thing 
occurs in many forms of disease. There is reason to believe that the car- 
Jx iization of the respired air has a great influence in all those cases where 
the number of respirations is greatly disturbed. 

Dr. M'Donnell finds that the number of respirations, and by inference 
the number of pulses, are much the same in passing over the same space, 
whether we run or walk, i. e. they depend as much upon the space tra- 
veled as on the time. Thus he "finds, if he walks one thousand yards in 
ton minutes or in eight, or runs over it in five minutes, the number of 
breathings are nearly the same. It is to be observed, however, that this 
rule does not apply to small portions of space, such as fifty or one hundred 
yards. These facts, he thinks, are all complicated with carbonization and 
muscular motion, so as to require separate investigations. 

In quadrupeds, especially when trotting or cantering, he has found that 
the steps, divided by the respirations, never give any fraction in the quo- 
Ti"V, i.e. thai these are universally proportional without any deviation. 
In man this does not occur, a circumstance which may arise from some 
peculiar anatomical or physical law in the connexion between the respira- 
tory and muscular construction of these animals." 

" While engaged hi these enquiries, about thirty years since, he had 
found that the pulse in the arteries of the foetus, before it breathed, was 
sloteer than in those of the mother. He had found also, that if the child, 
when born, remained for some time without breathing, the pulse continued 
slow during that interval, and became accelerated only at the instant it took 
its first breath. This fact appearing to him new, he had investigated the 
circumstance in the cow, and finding the phenomena similar, he had commu- 
nicated his observations to Dr. Clarke, Dr. Labatt, Dr. Stokes, and Dr. 
Douglas in Dublin, none of whom had ever noticed it in any other. Dr. 
Jeffrey mentioned it in his lectures, and in his * Observation on the Heart 
and on the Peculiarities of the Foetus,' and thought it might hold true of 
quadrupeds, and of all warm-blooded animals. He thought it probable that 
the foetus before respiration was in the condition of a cold-blooded animal, 
and partook of that slowness of the pulse which characterizes the tribe." 



108 British Association. ^J uly , 

Dr. Collins observed that, from the experiments he had made on the 
subject, he had come to a very different conclusion. "He had invariably 
found the circulation of the foetus much quicker than that of the mother." 
In this observation we concur. Why should the circulation be quicker in 
children than in adults, if it were slower in the icstus than in the child. 
Perhaps the respiration may account for this dhTerence. 

Fourth Day. Bruit de Soirfflet, (Blowing Noise.) 

" The sound to which bruit de soufflet has been given, is produced in va- 
rious parts of the circulating apparatus. Its existence has been ascertained 
within a comparatively short period, and is due to the inquiring spirit of 
modern investigation. Few things are more interesting, as objects of pa- 
thological curiosity, than the production of sounds in the vessels of the hu- 
man body under certain circumstances. The nature of these sounds has 
been examined with all the attention which the subject deserves, and not. 
only has their existence been determined, but it lias been iound that they 
constitute some of the most important signs of disease. 

It is interesting to inquire, on what peculiar mechanism bruit de souffle! 
depends, as unless we are properly acquainted with the manner in which it 
is produced, we never can apportion to it its due importance, or estimate its 
proper value as an indication of morbid change. The first part of this 
communication I shall not read ; it consists of an analysis of the various 
opinions of others, as to the mode in which this sound is formed. I shall 
merely s^ate, that Laennec supposed it to arise from spasm ; and to Dr. 
Williams, who has followed him in the same path of inquiry, we owe the 
suggestion that it might be found to arise from the operation of physical 
ca uses. Dismissing the examination of these and various other opinions, I 
shall proceed at once to the statement of my own views on the production 
of t iiis sound, remarking in limine, that it is heard under a great variety of 
circumstances. We hear it in narrowing and in dilatations of the aorta, in 
narrowing of the ventricular opening from disease of the valves, and in per- 
manent patency of the aorta, in varicose aneurisms, in aneurismal varix, in 
the vessels of the uterus during pregnancy, and even in vessels without 
any appreciable disease. For the production of bruit de soufflet the simul- 
taneous presence of the two following conditions are necessary: — first, an 
irregular current-like motion of the blood, (instead of its natural equable 
movement,) tending to produce corresponding vibrations on the sides of the 
art Ties or cavities through which it passes; and secondly, the state of the 
art- ri^s or cavities themselves, by which, instead of being kept in a state of 
tense approximation on their contained inelastic blood (and which would 
necessarily prevent any vibration in their sides), they become free to vibrate 
from the play of the currents within on their parietes, and by these vibra- 
tions give to the sense of touch 'fremissement,' (trembling) and to the sence 
of hearing 'bruit do soufflet.' 

If you press on the femoral artery below Poupart's ligament, so as to di- 
minish the calibre of the vessel, you necessarily diminish the supply of blood 
to 'he artery below the point of pressure, while the outlet through its 
branches continues as before. You do not interfere with the action of the 
hi rt above or the artery below, you merely diminish the area of the vessel 
at ho part where pressure is applied. Now if a linger be placed en the 
artery, a short distance below the point of pressure, a fremissement 
is Pelt, and if the stethoscope be applied over the same spot, bruit de 
soufflet is heard. This BOi rid is present in a very roinarkabc degree in nar- 
ro.vmg of 1 he auriculo-ventricular openings of the heart, In this disease the 
free edge of the valves is most commonly the seat of morbid action, it be- 
comes thickened and drawn in, and thus narrows the opening. Now the 
ventricle after each contraction leav< s :{ s Bides in a flaccid state, favourable 
for being acted on by the next gush of blood from the auricle into the ven- 



1836.] British Association. 109 

tricie. The consequence of this is, that the fluid, passing through the nar- 
rowed auricuio-venincular opening, is, in obedience to a well-known law in 
hydraulics, thrown into diverging currents, and if the hand be applied to the 
chest, a frennssement may be felt, and a loud bruit de soulhet heard. 

Having mentioned the occurrence of bruit de soufflet in the narrowed 
state of an artery, as also in narrowmg of the auriculo- ventricular ope sni 
1 shall contrast with those a peculiar condition of the aorta, viz. permanent 
Dcy of its mouth, in which the sound is heard without any narrowing 
whatever. [Dr. Corngan here exhibited drawings of the disease in ques- 
tion.] In some of these cases, the semilunar valves nave perforations or 
holes in them; in others they are thickened and bound back to the sides of 
the aorta ; in others they are ruptured. In some instances, however, the 
valves remain healthy, the mouth of the artery becoming dilated, so that 
they cannot close across its mouth ; and in these instances, how is this 
sound produced ? It arises from the artery not admitting, hi these condi- 
tions^ of being kept in a sufficiently tense state, so that at the next rush of 
blood the blood sent in does not move equally, and this current-like motion of 
the blood playing on its sides produces in them corresponding vibrations, 
and the sound is heard. 

I have noticed all these cases to show under how many various and see- 
mingly contradictory circumstances it may occur. • During pregnancy it 
may be distinctly heard in the vessels of the uterus after the fourth or fifth 
month. If we examine the state of these vessels, we shall find that the con- 
ditions necessary for the productions ot bruit de soufflet are present. Their 
free anastomosis with veins and sinuses permits them to become partially 
flaccid in the intervals of the heart's contraction, their sides are thin, and the 
rush of blood into these comparatively flaccid tubes at the next contraction 
of the ventricle, gives rise to the current-like motion en which the sound de- 
pends. The existence of similar conditions will explain its occurrence in 
varicose aneurisms and aneurismal varix. 

Having alluded to these cases in which it is heard in certain diseased 
conditions of the heart and arteries, I may notice those cases in which its 
occurrence is unconnected with vascular disease. If a patient be blooded 
too much, or if an animal be dying from the effects of haemorrhage, this 
sound is heard in the heart and great vessels. Here, in consequence of the 
quantity of blood which has been abstracted, the equilibrium of the circula- 
tion is destroyed, and the arteries not having a sufficient quantity to keep 
them in a tense state, bruit de soufflet is the consequence. We also meet 
with it occasionally in the healthy state of the heart, hi nervous and irritable 
individuals. In this case the equilibrium ot the circulation is destroyed by 
various causes of excitement, and the calibre of the vessels becomes dis- 
proportioned to the quantity of contained blood, so as to give rise to a cer- 
tain degree of flaccidity of their walls. It is a well known observation, that 
this sound is never heard in plethora or inflammatory fever, for in these con- 
ditions of the system, there is not room for the vibrations of the arterial 
tunics. 

Dr. Corrigan concluded, by detailing an expriment in proof of the fore- 
going theory. 

A small bladder in one instance, and a length of gum-elastic tube or gut 
in another, were interposed between two cocks, the upper connected with 
a water cistern ; the cock at the other or lower end being the discharging 
orifice of the bladder or gut. On allowing the water to flow through, the 
sound of bruit de soufflet and the sensation of fremissement were percepti- 
ble in the intervening bladder or tube until (from the upper pipe pouring in 
fluid faster than the lower discharged it) the bladder or gut became tense, 
and then both sensations ceased, the discharge of fluid from the lower pipe 
continuing all the time. This experiment was applied to explain the occa- 
sional presence or absence of bruit de soufflet in aneurisms , the sound be- 
ing present in an aneurism, if the parietes can from any circumstance be- 



110 British Association. [July, 

come at all flaccid in the interval of the heart's contraction, and being ab- 
sent where the parietes are distended and tense." 

The than!:? of the meeting were voted to Dr. Ccrrigan by Mr. Cramptcn. 
Dr. Harty had observed bruit de soufflet in all the arteries where a polypus 
of the left ventricle of the heart existed. Dr. Williams observed that his 
views had not been stated quite correctly by Dr. Corrigan. He had attribu- 
ted the bruit de souiliet to narrowing or obstruction of the vessels; but he 
did not deny that circumstances might modify the course of the blood, and 
have a share in producing it. H r - thought Dr. Corrigan's explanation would 
not apply to ossified aorta, in which the bruit is sometimes heard. But Dr. 
C. was able to defend his doctrine against all objections. 

" In reply to Dr. Williams' observations he would say, that he was aware 
of the esistence of the bruit in ossification of the aorta. In such cases, when 
the first current has been thrown back, the next impinges on a portion of the 
tube most likely to be thrown into sonorous vibrations. This circumstance 
had been already noticed by Dr. Wm. Stokes, and he had remarked that 
where this intense musical sound occurs, you may guess fairly that the dis- 
ease is ossification of the aorta." 

A paper was then read by Dr. Perry, of Glascow, on typhus ; but no par- 
ticulars are published. An ingenious curved drill catheter was shewn by 
Mr. L'Estrange when the meeting was adjourned. 



1836.] Pathological Anatomy of Phthisis. Ill 

Part III.— MONTHLY PERISCOPE- 

Pathological Anatomy of Phthisis. 

The plan of medical improvement which now occupies the 
profession, of investigating with the knife in the most careful 
and patient manner the seat of disease, preserving the morbid 
specimens, and illustrating the views obtained, by paintings 
and coloured engravings, is worthy of all attention. It cannot 
fail to afford important aid to diagnosis, and consequently to 
therapeutics and prognosis. Whilst, therefore, we should be 
careful lest, by our observations on the mortal effects of disease, 
we be drawn into improper theorizings ; and whilst we are 
particularly cautious that we be not led to look to those effects 
of disease as the only cause ; we cannot, on the other hand, fail 
to derive great benefits in practice by as full a knowledge as 
may be obtained of their pathological truths. 

Few things, therefore, can be more valuable to us than minute, 
candid and faithful accounts of these phenomena, as detailed by 
those of ample talents, and who have no favorite doctrine to 
sustain ; but only search for the truth as exhibited by nature 
herself. 

The excellent opportunities afforded M. Louis, in the Hospi- 
tal of la Charite, during some years in the prime of life, with 
the vast store of the most valuable acquirements of which he 
was previously possessed, to which we may add his present 
service in the Hospital of la Piete, and an independence of mind 
and a spirit of honest research after truth, alike creditable to the 
moral and intellectual man, have enabled him to determine the 
fallacy of some of the fashionable and exclusive doctrines of his 
late preceptor, M. Brous-.ais; and to establish many facts of pri- 
marv importance in the pathology and diagnosis of Phthisis. 

We shall direct our attention for the present to a few of 
those results, which we have extracted from the Medico- 
Chirurgical Review, the truth of which, says the English 
Reviewer, M. Louis has the merit either of having first an- 
nounced and proved ; or if they had been discovered before, of 
having finally and irrevocably established. 

1. The existence of tubercles in any organ or tissue of the 
body, after the age of fifteen, indicates their simultaneous pre- 
sence in the lungs* 

2. Tubercles, when co-existent in the lungs and in other 
parts of the body, are invariably more advanced in the former ; 
whereas, in the latter, the developement is usually equal. 

♦Whilst the experience of M. Louis in these is confirmed by Dr. S' acker, 
C. Smith, Bonitus. Morfrasmi and others, it is contrary to M. Lienttoe's 



112 Pathological Anatomy of Phthisis. [July, 

3. Tubercular deposition almost invariably commences in 
the upper lobes of the lungs; it is found mure frequently in the 
left than in the right side, in the proportion, as far as his obser- 
vation has gone, of five cases of the former to two of the latter. 

4. Simple Bronchitis commences at the base of the lungs, 
pursuing a course inverse to that of phthisis. 

5. Chronic Peritonitis generally indicates pulmonary tuber- 
cles. 

0. Large vomicae are generally nearer the posterior than the 
anterior surface of the lobes of the lungs. 

7. Large excavations are almost exclusively formed in the 
upper lobes ; and it is a very rare occurrence that when a very 
small vomica is discovered in the lower lobes, when the upper 
ones are altogether exempt. 

8. Although tuberculous deposition more frequently takes 
place on the left than on the right side, still, in a large majority 
of cases, both lungs are simultaneously diseased. 

9. Of eight cases of vomicae which had opened into the cavity 
of the pleura, seven were observed on the left side. 

10. The great tuberculous excavations of the upper lobe 
were nearer the posterior than the anterior edge of the longs : 
nnd in many instances their sides in the former direction w T ere 
found almost wholly formed by a false semi-cartillaginous mem- 
brane from a line to a line and a half in thickness, enveloping 
the summit of the organ, lnferiorly they were sometimes only 
separated from the pleura of the interlobular fissure by a thin 
layer of pulmonary tissue, more or less modified; or there was 
a perforation of their parietes communicating with another ex- 
cavation situated in the posterior part of the inferior lobe. In 
no instance did M. Louis find extensive excavations in the cen- 
tre of the lower lobes. 

" These, and other results of M. Louis' researches," says the 
reviewer, " speedily attracted the attention of his cotemporaries ; 
and although they were contradicted and cavilled at on their 
first announcement, their truth and value have since been very 
generally admitted, and have tended to establish the reputation 
of the author as one of the ablest pathologists of modern 
times." Such are the merits of this acute and independent inves- 
tigator, and such the power of truth, that, we are informed, "by 
far the greater number of the advanced students in Paris, (prin- 
cipals English, American, and German.) have of late deserted 
the Clinique of M. Broussais, and now follow the visits and lec- 
tures of his pupil." 

The extremely accurate and minute observations of M. Louis, 
on the whole one hundred and twenty-three cases of his inspec- 
tion, do not confirm the observation of Laennec and others, of 
the existence of cavities communicating with the bronchia, and 
lined, as in tuberculous excavations of long standing, with a 



1836.] Pathological Anatomy of Phthisis. 113 

light grey false membrane, semi-cartilaginous and semi-opaque, 
surrounded by healthy pulmonary parenchyma ; for he found 
this in no one case. He also failed to meet with those masses 
of condensed cellular tissue in which the bronchial ramifications, 
more or less dilated, terminate ; and which Laennec considers as 
the. cicatrices of tuberculous cavities. 

We think it strange, but nevertheless not impossible, that the 
observations of all may have been correct, and that in Louis' 
one hundred and twenty-three cases, there may have been none 
of those cicatrices which were observed by others. But we 
would suggest a view of this phenomenon, which may perhaps 
tend to reconcile these apparently opposite observations. We 
are of the opinion that abscesses do form in the lungs, as simple, 
and every way of the same character as those which form in 
the superficial cellular tissue ; that they terminate by suppura- 
tion, and discharge through the bronchii ; and entirely heal, and 
the patient recovers from all appearance or evidence of disease. 
This opinion is founded on actual observation of facts. The 
fact relative to this matter, then, is probably this, that those 
masses of condensed cellular tissue, and fibrocartilaginous 
membrane which were by Laennec and others considered cica- 
trices, were really those of obliterated or healed, but not of 
genuine tubercular cavities — that they were only the cicatrices 
of abscesses which had been previously formed in the pulmonay 
parenchyma, discharged and healed ; after which, and when 
the strumous character of the case became more completely 
developed, genuine tubercular cavities were formed. 

11. In one hundred and twelve cases, M. Louis found but 
one case in -which both lungs were free in their whole extent 
from adhesions between the surfaces of the pleura. In eight 
cases the right, and in seven the left lung did not adhere at any 
point of their surfaces. It appears that the pleural adhesions 
indicated, by their extent, firmness, &c. the number and size of 
the tuberculous excavations of the lungs. 

12. M. Louis observed in one-tenth of his cases, that pleuritic 
attacks had been made in the last stage of pulmonary Phthisis, 
as evinced by a layer of soft yellowish coagulable lymph on 
points of the pleura, indicating its formation within four to 
eighteen days preceding death. 

13. The false membranes, formed by pleural inflammation, 
were found in a few instances to have acquired quite a car- 
tilaginous firmness, in consequence of the deposition of genuine 
tuberculous matter in them. 

14. An effusion into the cavity of the pleura of a clear fluid, 
in quantity a pint and upwards, was found in one-tenth of the 
cases. This, M. Louis believed, had taken place very rapidly ; 
because he had found in two instances, that the thorax gave 
<'Vcrv where a Very clear sound on percussion thirty-six hours 

15 



114 Pathological Anatomy of Phthisis, [July. 

before death, in which, after death, he found two pints of fluid 
in one side of the chest. 

15. In thirty-one out of one hundred and two cases examined, 
there was ulceration of the mucous membrane of the bronchia, 
with or without inflammatory redness of its surface. These 
ulcers were round or oval ; and when small, were scattered 
throughout the circumference of the air-tube, and varied from 
a line to a little more or less in diameter. These, we are told, 
have, from their edges being flat, and their base formed by the 
cellular tissue, slightly or not at all thickened, escaped the at- 
tention of many pathologists. 

16. The ulcerations are usually more numerous and large in 
the lower than in the upper half of the trachea. 

17. The large ulcerations of the trachea are more scattered 
and apart than the smaller ones ; and are generally found on- 
the posterior, fleshy part of the tube. 

18. In two cases M. Louis found a certain number of the 
cartilaginous rings completely denuded, diminished in thickness, 
and either partially or entirely destroyed ; and in five cases 
the complete destruction of the mucous membrane of the tra- 
chea throughout almost the whole extent of its fleshy portion. 

19. These anatomical investigations have proved that the 
symptoms of ulcerated trachea are very obscure. Pain, with 
a sense of burning, and of obstruction just above and behind the 
sternum, was experienced in a few cases. These distresses 
were sometimes referred by the patient to the larynx, whilst 
this part was exempt from disease, and only the trachea ulcer- 
ated. 

There were no pathognomonic characters in the breathing, 
cough, or expectoration. As an example, in one case wherein 
the whole length of the wind-pipe, with the epiglottis, including 
the appendages, to the termination of the trachea, exhibited 
patches of deep and extreme ulceration, so that some of the 
cartilaginous rings were denuded, and others more or less com- 
pletely destroyed, no prominent symptoms were present during 
the life of the patient. 

20. Simple in^ammation of the trachea is more frequently 
accompanied with pain, and a sense of heat in the part, than 
ulceration. 

21. Ulcerations of the larynx are more frequent than, but are 
very rarely unaccompanied by, those of the trachea. They 
were found in twenty-two out of one hundred and two cases. 
They were generally more or less irregular, of a certain depth, 
and from one to two lines broad, their edges of variable thick- 
ness, sometimes lardaceous, and greyish or whitish ; the mucous 
membrane was pale, and perfectly sound in the rest of its 
extent. 

22. The most frequent seat of laryngeal ulcerations was first 
the junction of the vocal cords themselves ; especially their 



183&.] Pathological Anatomy of Phthisis. 115 

posterior part. Only once was a very small ulceration obser- 
ved at the back of the arytenoid cartilage, the superior part of 
the larynx, and the inferior of the ventricles. Sometimes one 
or more of the vocal cords were completely destroyed, and the 
base of the arytenoid cartilage laid bare ; the cartilages them- 
selves remaining unaffected. 

23. The signs which during life, characterize ulcerations of 
the larynx, are much more obvious than those which accompany 
ulcerations of the trachea. They vary according to the part of 
the tube affected, and the depth and extent of the ulcers. When 
the vocal cords, the ventricles, or the arytaenoid cartilages were 
the seat of disease, hoarseness, more or less alteration of the 
voice, pain, sense of heat, and pricking, and subsequent aphonia 
were generally present. The pain was sometimes very acute, 
pungent and lancinating, and in most cases exasperated by 
coughing, speaking, &c. 

24. Ulcerations of the epiglottis were almost as frequently 
found in phthisical patients, as those of the larynx. Of one 
hundred and two cases, eighteen were found to have ulcerations 
of the epiglottis. i hese were sometimes found alone, but most 
commonly associated with those of the larynx and trachea ; so 
that twelve cases out of eighteen were thus associated. Only 
in one case was the ulceration on the upper surface of the 
valve. In four cases was the edge festooned by ulceration, and 
in one was there complete destruction of the epiglottis. 

25. In no instance were tubercular granulations found in the. 
substance, or on the surface of the epiglottis, larynx, or trachea. 
This led M. Louis to conclude that inflammation was the most 
frequent cause of their ulcerations. 

20. These ulcerations were twice as frequent in men as in 
women. This M. Louis considers not the effect of hazard; 
because the proportion was about the same in the three species, 
viz. six examples of this state of the epiglottis in women, out of 
eighteen, seven of the larynx out of twenty-three, and nine of 
the trachea out of thirty-one cases. 

27. The symptoms of ulceration of the epiglottis are often 
obscure ; but may be stated to be a fixed pain in the upper 
portion of, or immediately above the thyroid cartilage, soreness 
of throat, hoarseness with greater or less dysphagia, increasing 
with the progress of the disease, so as to cause fluids to be 
rejected by the nose ; the pharynx and tonsils remaining healthy 
at the same time. 

As symptoms during life are more or less equivocal with 
regard to those ulcerations which attend genuine Phthisis, we 
feel it important to familiarize the reader, as much as possible, 
with those which are more or less connected with such cases. 
We therefore give the following case, in which the epiglottis, 
fhc lateral ligaments, and tho superior vocal cords were found 



1 10 Medicinal Leeches. [3 u h'> 

after death completely destroyed, and in which the succession 
of symptoms was well marked. 

At first the voice was hoarse, unequal and discordant ; a 
lancinating pain was felt between the thyroid cartilage and the 
os hyoides ; this was increased by any exercise of the vocal 
organs, by flexion of the neck forward, and by deglutition ; the 
latter being frequently so difficult as to provoke the rejection of 
fluids by the nose. Towards the close of the case, the pain in 
the neck became more severe, and the deglutition so destroyed, 
that no solid food could be swallowed ; complete aphonia had 
supervened. The progress of these symptoms had been slow 
and constant — the rejection of the liquids by the nostrils having 
existed for four months preceding the death of the patient : and 
the acute local pain had been felt during the whole of this pe- 
riod. " It is however," says M. Louis, " to be remembered that 
these symptoms are by no means invariable occurrences, even 
when the destruction of the epiglottis is complete." 

Magendie relates two such cases, in which deglutition was 
not at all impeded. 



Medicinal Leeches. — We find, by an advertisement in the 
Boston Medical and Surgical Journal, that the Massachusetts 
Medical Society have, with a spirit and liberality becoming 
Americans, offered a premium of jive hundred dollars, for the 
best sample of not less than one thousand leeches from a foreign 
stock, bred in that commonwealth — the premium to be awarded 
at the expiration of seven years, if occasion should be. 

We are much pleased with the spirit which actuates that 
respectable body to such a movement. 

It appears to us, however, unnecessary to require that they 
should be propagated from a " foreign stock." This requisition 
is calculated to embarrass the experiment with unnecessary 
expense and trouble. 

Some of the varieties (of which there are a number,) of the 
native leeches which abound in our creeks, branches and swamps 
at the South, are, when well selected, found with us to answer 
all the purposes to the fullest extent, of the best foreign speci- 
mens. They arc brought in by the country people, and sold to 
the apothecaries and physicians at six to twelve cents. Many 
are of small size — others are very large. Doubtless they would 
be much improved by a system of management which a minute 
knowledge of their natural history could afford. Last autumn 
we had occasion to deplete from the dorsal region for the relief 
of spinal irritation, which had produced colic and other neu- 
ralgic distresses to a considerable extent. Knowing that there 
wex*e no foreign leeches in tlie city, we prescribed forty domes- 



18.36.] Cancer of the Lap. 117 

tic. Our apothecaries sent us the remnant of their stock, 
amounting to twenty-six, qll of which were applied on the dor- 
sal vertebra). Not one of the whole number failed to operate. 
They were allowed to remain until they dropped. The deple- 
tion was afterwards encouraged by warm napkins for twenty 
or thirty minutes, by which time the patient became very sick 
arid faint. The circumstances render it reasonable to suppose 
that between tw r o and three pounds of blood were lost by the 
operation. The depletion was indeed excessive ; so much so 
that our patient was troubled for a week thereafter with a cold- 
ness of the extremities, and debility with oedema, such as ordi- 
narily follow excessive haemorrhage. The same leeches have 
been preserved during the past winter, with no more care than 
daily changing the water in which they were kept ; notwith- 
standing the bottles in which they were have been sometimes 
broken by the freezing of the water, which was entirely con- 
gealed. These leeches were left charged with the blood which 
they had imbibed at their first application in October. They 
have all been since used with the best effect, except two which 
died in the beginning of spring, and two which are still on hand. 

There was no selection of these — they were the remainder 
of a considerable supply which had been but a few weeks be- 
fore received, and were probably the smallest of that parcel. 
None of them w r ere, however, less than six, and many of them 
upwards of seven inches long, when swimming or suspending 
themselves by one end in the bottle. They were larger than 
most of those which are brought to this market ; but our 
apothecaries inform us that there are certain streams in the 
neighbourhood winch afford such samples abundantly. 

An observation of the peculiar character of the streams and 
places where they are found, would doubtless afford some use- 
ful hints relative to procuring as well as propagating them. 



The following very interesting case, serves well to illustrate 
the wonderful resources of the system and powers of surgery, 
for surmounting inveterate and otherwise mortal disease. We 
scarcely know what we may not expect from the knife, with 
good constitutional powers. 

Cancer of the lip — resection of the lower jaw. — M. August. Marseille, in a 
recent letter to Dr. Clot-Bey, gives an account of a very extensive opera- 
tion on the lower jaw and the neighbouring parts. The patient had been 
attacked three several times' with cutaneous cancer of the lower lip. — Twice 
the tumour was excised, but the third time, the disease had made horri- 
ble progress before surgical aid was requested. When the case was pre- 
sented to M. Marseille, the condition of the patient was as follows : — 
He was decidedly attenuated, his complexion pale yellow, with a slight 



ILS Removal of Sequestra without an Operation. [Juh. 

h aden hue, and there was no fever. The cancerous afi'ection invaded ex- 
ternally al] the lower lip and parts about the chin, extending, in the shape 
of hardened lump.--, to the region above the hyoides. All these parts were 
in a disgusting state of ulceration, pouring out foetid pus. The lower jaw 
lied and softened to within half an inch of the angles, the teeth dis- 
ci and sticking here and there over the tumour, and the sublingual 
cellular tissue in a decidedly cancerous condition. The operation being 
demanded by the patient, and refused by the surge on, the former declared 
his determination to commit suicide unless indulged in his wish, on which 
the latter reluctantly consented. The mouth was dilated by cutting the 
commissures to the right and left above the level of the diseased shin, and 
from the extremities ot these incisions two others were carried down ob- 
liquely, until they met each other at the little groove or centre of ihe cs 
hyoides, thus enclosing all the diseased parts in one large V incision. The 
lower i aw was then sawed through by a chain saw, within half an inch of 
each of its angles, and the bone, with the mass of the diseased parte, v ere 
then removed by the straight bistoury. The frenum lingute was next Fo- 
rmed by waxed thread, and the tongue thus held aside by an assistant, 
while the diseased sublingual tissures were dissected off by curved scis- 
sors and forceps. Many vessels were secured seriatim, and the patient, 
was imminently threatened with suffocation, but no actual cautery was ne- 
cessary. The wound was nearly closed by six points of suture, one of 
which held and drew forward the frenum linguae, and by a methodical ban- 
da{*e. The shocking deformity was concealed by an artificial jaw 7 or mask, 
and the constant percolation of saliva was prevented by a sponge. The 
patient departed for his native village two months after the operation, eat- 
ing easily and speaking intelligibly. — A/ii. Jour. — Gaz. des Hopitaux, 
May 9//(*1835. 



O;? the Removal of Sequestra without cm Operation. — Dr. Bouget has pub- 
lished a new plan for the removal of sequestra without an operation, in the 
Journal de la SactiM de Medecine de Bordeaux^ in an article entitled, 
"Souvenirs de la Clinique de Delpcch." 

M. Delpcch, discouraged at the unfortunate results in several cases of 
necrosis of the tibia, turned his attention to measures which might remove 
the sequestrum without having recourse to the painful operation which is 
ary. In this search he was successful, for he found that, 
by means of diluted sulphuric acid, lie could destroy the phosphate of lime 
m the bone to be removed, which is then reduced to its gelatinous paren- 
chyma, and can be easily taken away with the common dressing forceps. 
D pech first employed this application in the year L814. At ihis period, 
Dunded at the battles of Orthes and Toulouse, flocked in such i am- 
bers to Montpelier, that the Hopital St. Eloi was soon crowded, and a 
supplementary one was formed, at the head of which was placed M. U.Fa- 
nce so well known by his valuable lectures on external pathology. — 
Hospital gangrene soon appeared in both hospitals, and caused such exten- 
sive ravages that the majority of the amputations terminated fatally: even 
in those cases which were the most successful, a greater or smaller portion 
of bono was Left exposed by the destruction of the soft parts, A young man 
who had undergone amputation of the arm, and had twice Buffered from hos- 
pital gangrene, winch had been with difficulty arrested, had the humerus 
projecting about an inch and a half beyond the flesh. According to the or- 
dinary treatment the sequestrum would not separate perhaps for months, 
bltt it happened far otherwise under M. Delpoelfs directions. He caused 
i he external surface of the hone to be covered with a pledget of lint, soaked 
in dilute sulphuric acid, and a wad of the same, equally wetted, to be passed 
into the medullary canal, whence the reticular apparatus had been prove- 



1830. J Treatment, tf Co lica Pictonton. 119 

ously removed ; at the end of twenty-four hours the portion of denuded bone 
was so softened that it could be easily detached : ton days after the extremit) 
bfthe bone was covered with fleshy granulations, and a complete cure was 
sjxv.'.'.ly accomplished. 

In the year iyl(>, a man entered the clinical ward, having a necrosis 
which extended through the whole length of the tibia. Although he evi- 
dently possessed a good constitution, and was apparently capable of under- 
going a serious operation, M. Delpech determined to have recourse to the 
proceeding which had proved successful in the previous instance. He des- 
troyed the soft parts at the upper part of the leg by means of the pot issa 
fusa, and when the eschar, winch was about the size of a crown piece, had 
sloughed, he applied a pledget of lint, soaked in the dilute sulphuric acid, to 
iii i bone ; after two or three dressings, renewed every live or six hours, if 
became .soft enough to be taken away by dressing forceps. This being ef- 
fected, the application of the potassa, followed by the acid, was made lower 
down ; the sequestrum was exposed to the extent of five or six inches in 
length, and an inch and a half in width ; it was then extracted with the 
greatest ease. It was more than six inches long, and constituted nearly 
two-thirds of a cylinder. The patient left the hospital quite well one month 
afl r his admission. 

From that time untd 1822, when I left Montpelier, adds M. Bouget, I 
have seen M. Delpech constantly have recourse to this plan of treatment, 
both at the hospital and in private practice, and always with success. I 
have also used it myself with advantage in a case of necrosis of the tibia in 
a child. — Amer. Jour, of Med. Sci. 



Treatment of Collca. Pietonum. Lead Colic cured bu Hy- 
drochloric Acid. — M. Gendrin communicated to the Academy 

of Sciences, at their sitting in December, 1834, some additional 
observations on the treatment of Colica Pietonum. He has 
ascertained that the administration of sulphuric acid does not 
produce the same relief where the colic has been induced l>\ 
the deutoxide of lead, as when it has been caused by the car- 
bonate. In white lead manufactories, the use of this acid has 
always been attended with the happiest prophylactic effects ; 
whilst, in those of red lead, it has proved powerless. He then 
announces that he has found that diluted hydrochloric acid would 
remove the poisonous effects of the deutoxyde, as rapidly and 
certainly as the sulphuric cures those caused by the carbonate. 

Am. Jour. Pharm. — Jour. Hebdom. 

It may be well to remark in this place, that the form in which 
lead is found in the hydrant water conducted through leaden 
service pipes in this place, and probably in all places, is that of 
carbonate. According to the cxperienor then in the treatment 
of this disease in white lead manufactories, the sulphuric acid 
would be found prophylactic of lead colics and other forms of 
disease liable to be produced by drinking hydrant water, and 
curative, when they are produced. 

The following is the formula of M. Foucat in the treatment- 
of lead colic. " To a pint of water, add half an ounce of sulphuric 



120 Correctives of Opium, <$-c. [July, 

Alcohol, (Elixir of Vitriol) two ounces of Magnesia, and four 
oupces of Syrup of Gum. This is to be used as a commi n 
drink ; besides which, a draught composed of half an ounce of 
Caster Oil, as much Lemon Syrup, and a quarter of a grain of 
Opium, is to be given night and morning." — Am. Jour. Pharm. 
Jour. Hebdom. 



Correctives of Opium. — According to M. Puchelt, a German 
physician, sulphate of soda is an excellent corrective of the 
unpleasant effects of Opium, given in the proportion of a scru- 
ple to half a grain of Opium. This dose may be repeated two 
or three times a day. In combination with Glauber salts, he 
says that Opium may be' administered when it would otherwise 
be contra-indicated. In obstinate haemorrhages especially, this 
mixture will produce the happiest effects. The author also 
asserts that if this neutral salt prevents the congestion some- 
times produced by opium, so castor prevents its narcotic effects, 
without diminishing its sedative powers. — Am. Jour, of Pharm. 
Load. Med. and >Sur. Jour, and Am. Jour. Med. Sci. 



Dignified Consistency. — The governors of the London Fever 
Hospital, an institution of high reputation, at a special meeting a 
few weeks ago, at which four hundred persons were present, 
removed Mr. Hentsch, the House Surgeon, from his office, in 
consequence of his having given a written testimonial in favour 
of a quack medicine. A resolution was brought forward, also, 
to remove Mr. Tweedie from the post of Chief Surgeon, for a 
similar offence; but before it was acted upon, the meeting 
adjourned for one week. Mr. Bransbury Cooper was present, 
and defended his professional brethren with considerable energy, 
but to no purpose. The further doings will be narrated when- 
ever the intelligence arrives. — Boston Med. and Sur, Jour. 



Antidote, for the poison of the Hygeidn (Morisoivs) pills. — 
A correspondent of the London Lancet makes known, for the 
benefit qi those who are guilty of the folly of taking Morison's 
pills, a remedy for the distressing vomiting and purging which 
frequently follow their use, viz. copious draughts of luke-warm 
water, which will assist the stomach in its attempts to dislodge 
ihe poison. Muciliaginous and gelatinous drinks, such as bar- 
ley water, linseed tea, mutton and chicken broth, will also miti- 
gate the severity of the purging, and afford some protection to 
the internal coat of the intestines from the acrid and irritating 
effects of the gamboge, aloes, and eoloevnth. which are found in 
the pills.-— Ibid, 



1836.] Butlers Aperient effervescing Magnesia, fyc. 121 

Butler's Aperient effervescing Magnesia. — Of all the frauds 
practiced upon the public, in these times of nostrums and quack- 
ery, this is one of the most shameful. It is called, forsooth, a 
magnesian preparation, and recommended as serviceable in 
heart-burn, acidity and the numerous ills dependent on acidity 
of the stomach ; and yet in the state in which it is swallowed, 
there is not a particle of alkaline property in the mixture; on 
the contrary, there is a considerable quantity of free acid 
remaining in the solution, after the effervescence has subsided. 
We shall here give the true composition and qualities of this 
fashionable absorbent, that those who are using it under the idea 
of its providing them with an alkaline medicine, to correct the 
dreadful inconveniences of Dyspepsia, may no longer continue 
to use this saline and acid preparation. For although, by its 
purgative properties, it may afford temporary relief to some of 
these dist esses, yet its continued use cannot fail to injure the 
stomach and lead to a stnte of hauitual constipation of the bowels. 

It is simply a mixture of Sulphate of Magnesia, (Epsom 
Salts,) Tartaric Acid, and super carbonate of Potash. — So 
that it purges by virtue of the Epsom Salts it contains. It is 
analogous in its effects and composition to the Seidlitz Powders, 
and far less pleasant to the taste ; for the neutral salt used in 
the composition of these last, is the Tartrate of Potash and 
Soda, (the tasteless purging salts.) In order to prevent the 
Tartaric Acid and super-Carbonate to be mixed with the Sul- 
phate of Magnesia, without exciting their mutual action upon 
each other, all the water of crystallization must be driven from 
it by he^t, which can be done without decomposing any portion 
of the salt. 

We object not to the preparation itself; it is useful in some 
cases, and frequently very convenient ; but our objections are 
against the imposing name which it bears, and the outrageous 
fraud attempted upon the public. F. 



Preservation of Anatomical Preparations. — M. Le Reboulet, 
conservator of the Museum of Natural History, at Strasburg, 
has given the following formula, for a liquid for the preserva- 
tion of anatomical preparations, &c. This fluid is peculiarly 
applicable to the preservation of the brain. When any tissues 
kept in this solution become hardened, as sometimes happens, 
they can be restored to their usual flexibility by keeping them 
in fresh water for a short time. 
R Water, 16 parts. 

Chloride of Lime, 4 parts. 
Alum, 2 " 

Nitre, 1 " 

Am, Jour. Pharrn. Jmcr tf.c Pharni. 
.16 



122 Influence of different Professions on Consumption. [July 



Influence of different Professions on Pulmonary Consumption. By II. C. 
Lombard, M. D., Geneva. — The following facts were derived from five 
sources, viz. 1. The list of cases collected by the pupils of the hospitals 
of Paris. 2. That of M. Julius, in his researches on the sanitary state of 
the town and hospitals of Hamburgh. 3. The Medical Annuary, published 
at Vienna in 1803, containing the sketch of the diseases treated in the 
General Hospital during the years 1798, 1799, and 1800. 4. The results of 
the recent researches of M. Benoiston de Chateauneuf, on the number of 
patients furnished by each profession to the hospitals of Paris, with the 
number of deaths caused in each profession by pulmonary consumption ; 
and 5. The results of M. Lombard's own researches in the mortality re- 
cords, from 1776 to 1830, of the city of Geneva, including the township of 
Plain-Palais and Eaux-Vives. All these sources afford him records of the 
death of 57,463 persons of various professions, 5,752 of whom died of pul- 
monary consumption. 

By ascertaining, in the several lists, how many of the professions of the 
subjects of this disease were above, and how many were below, the average,' 
in the number of cases of consumption which they furnished, and by subse- 
quently comparing the results together, he was enabled to arrive at the 
following facts : 

Professions situate above the mean. 

" A. In men. 

"1. In all the lists. — Sculptors, printers, hatters, polishers, gendarme*, 
brush-makers, soldiers, jewellers, tailors, millers, quiltmakers, lacemakers, 
lemonade dealers, domestic servants, and wigmakers. 

"2. In the majority of the lists. — Copying-clerks, cooks, turners, joiners, 
barbers, cordwainers, and coopers. 

"3. In a single list. — [M. Lombard gives a great many professions, but 
we select only those of our own country.] Ironmongers, commission agents. 
brokers, tin smiths, pavers, engravers, design-painters, street-sweepers, 
pastry-cooks, teachers, draymen, upholsterers, file-makers, chimney sweeps, 
feather-dressers, lapidaries, &c. &c. 

" B. In women. 

"1. In all the lists. — Laundresses, cordwainers, and embroiderers. 

"2. In the majority of the lists. — Polishers. 

"3. In one list. — Dress-makers, teachers, smoothing-ironers, knitters 
flower-makers, lace-women, &c. &c. 

"A. In men. 
r "Students, plasterers, stone-cutters, saddlers, terrace-makers, clock- 
makers, carmen, cellar-butlers, goldsmiths, stocking-makers, charcoal deal- 
ers, gilders, musicians, sawyers, and glass-makers. 

" B. In women. 

"House-keepers, day-labouring-women, wire-workers, weavers, gauze- 
makers, gilders, patchers, and mantua-makers. 

" 3. Professions situate below the medium average. 

" A. In men. 

" I . In all the lists. — Coachmen, quarrymen, carpenters, inn-keepers, 
butchers, hall-porters, wharf-porters, street-porters, tanners, bleach* re, 
watermen, confectioners, slaters, founders, infirmary-attendants, and nurses. 

"2. In the, majority of the lists. — Bakers, blacksmiths, farriers, locksmiths, 
masons, and weavers. 

" 3. In a single list. — Surgeons, braziers, cutlers, different merchants, 
wood-cutters, advocates, agriculturists, literary men, grocers, public officers, 
ninders, druggists, annuitants, groojns, dyers, physicians, lawyers, candle* 



1 836.] Influence of different Professions on Consumption. 120 

makers, snufF-dcalers, book-sellers, harness-makers, professors, miners, 
mercers, comb-makers, &c. &c. 

"B. In women. 

" 1. In all the lists. — Wadding carders, infirmary nurses, bleachers, and 
garden women. 

"2. In the majority of lists. — Dress-makers. 

'• -i. In a single list. — Cooks, domestic servants, annuitants, laundresses, 
grocers, midwives, bakers, appliers of leeches, door-keepers, &c. &c. 

M. Lombard's next inquiry is into the causes which may influence the 
frequency of Consumption in (liferent professions, and under the following 
heads he has arranged the results of his researches : 

I. State of comfort or indigence. — His calculations show "that the more 
indigent classes of society are twice more accessible to consumption than 
the persons more elevated in the social scale." 

II. Muscular Exercise. — Of the eighty professions situate above the 
average, fifty-eight, or nearly three-fourths, are almost completely seden- 
tary. A fact showing that the sedentary life furnishes a much great r 
number of consumptive cases than an active life. The proportion M. 
Lombard found to be that of 141 to 89. He also ascertained that "con- 
ditions completely sedentary produce a greater number of consumptive 
patients than those which require a certain degree of muscular exer- 
cise ; and from it may be inferred, that if the sedentary life augments 
the frequency of consumption, muscular exercise is in some degree a means 
of counteracting tins influence. 

Concussions given to the chest by the continual motions of the arms, 
which have been enumerated among the causes of consumption, he found 
to have a tendency varying according to circumstances — in slightly dimin- 
ishing the frequency of consumption in sedentary occupations, and augment- 
ing that frequency in active professions. 

The constant exercise of the voice he statistically proves, is not an un- 
favorable circumstance in reference to consumption. The mean number of 
victims to this disease being one hundred and fourteen in one thousand — 
that of the professions in which the voice is much exercised is only seventy 
five ; — a result in accordance with the observations of M. Benoiston de 
Chateauneuf, and with the experience of the celebrated Cuvier, who asser- 
ted that the frequent exercise of his voice, consequent upon his appointment 
to a professor's chair, was the means of curing him of a pulmonary affec- 
tion. 

The incurvated attitude is unfavorable in reference to consumption, but 
is more so in those professions which are completely sedentary than in 
those in which much muscular exercise is required, where this influence 
is fully corrected by the exercise of the muscles. This conclusion is 
strengthened "by the rarity of consumption among tanners, gardeners, 
bleaching and washing women, who are constantly bent at their work." 

III. Influence of the purity or impurity of the surrounding atmosphere. — 
An epitome of the results of liis comparisons and calculations under this 
head^is as follows : 

1. Those workmen who pursue their occupation in the open air are 
twice less liable to consumption than those who work in shops, and the 
degree of liability is in proportion to the smallness of the shop, or the im- 
perfection of ventilation. 

'2. Workmen surrounded by an atmosphere charged with watery vapour 
— for example, dyers, tanners, washer- women, &c. are much less liable to 
consumption than the general average. In Geneva, the average number 
in this class of workmen who are attacked with consumption is inferior, 
cnore than one half, to tho general average. 



124 Influence of different Professions on Consumption. [July, 

3. On the contrary, workmen surrounded by a hot, dry atmosphere, 
yield more readily than other workmen — in the proportion of one hundred 
and twenty-seven to one hundred and fourteen. 

4. Workmen surrounded by animal emanations, butchers, tanners, can- 
dle-makers, sick-tenders, &c, are about twice less liable than others to 
contract pulmonary consumption. The exact proportion is sixty to one 
hundred and fourteen. 

5. Air loaded with emanations of living plants, (in day-time of course,) 
is a preservative against consumption. The emanations, from fermenting 
or decomposing vegetable substances, on the contrary, are injurious ; and 
the volatile vegetable oils, as turpentine, the drying oils, &c, exert a very 
unfavorable influence. 

G. Among the mineral emanations, are the gazes arising from the 
combustion of charcoal, w r hieh are unfavorable : the vapours of the mineral 
acids, which are not as unfavorable as is generally believed : chlorine,, 
which has been used as a remedy in consumption. M. Lombard asserts, 
that consumption is rare among the workmen employed in the manufacture 
of chlorine. He tested the statement as to the harmlessness of this gag 
in a great manufactory of chloride of lime. "The only inconvenience 
felt by a workman who had been employed in it for more than twelve- 
years, is a transitory uneasiness, when one of the retorts, from which the 
chlorine is disengaged, happens to break and to diffuse the vapours 
abundantly in the manufactory." 

Metallic emanations, he found, are not directly injurious to the lungs r 
and notwithstanding their action on the nervous system, and the debility 
which they produce, the production of consumption does not seem to be one 
of their secondary effects. 

7. Bodies suspended in the atmosphere are highly injurious to the lungs. 
Mineral particles are more so than animal, and these more so than 
vegetable particles. Coarse particles are less hurtful than minute ones, 
and hard particles are more injurious than soft ones. Hence, "the 
powders most hurtful to the lungs are those which proceed from very hard 
bodies, and are reduced to an impalpable powder." The inhalation of the 
dust of emery, steel, or flint, is well known as a frequent cause of con- 
sumption. 

" The workmen who employ emery, the hardest of all the substances 
used in the arts, are also the first in the order of frequency of consumption. 
Thus the watch-hand makers present fifty-five per cent., and the steel- 
polishers furnish thirty-five per cent., of consumptive cases. 

" Almost all the workmen employed at Sheffield in polishing steel, be- 
come the prey of pulmonary consumption. It has been observed, that in 
two thousand five hundred persons employed in this department, scarcely 
thirty five reach the age of fifty years, and scarcely seventy that of forty 
five years : while the majority die before the thirty sixth year. Dr. John- 
son remarked, in 1799, the great frequency of consumption among the 
workmen occupied in pointing needless on ground stones ;* and recently. 
Dr. Knight, of Sheffield, published anew memoir on the same subject, aud 
has added new facts to those already known. f He remarks, that no polish- 
er of steel-forks reaches his thirty sixth year. Among two hundred and 
fifty steel-polishers admitted into the dispensary of Sheffield, one hundred 
and fifty four had diseases of the chest, and thirteen died within the year; 
while of two hundred and fifty pursuing other professions than that of pol- 
ishing, fifty six only had diseases of the lungs, and only one died within the? 
year. The age of eight hundred and twenty seven of these patients deserves 
to be remarked. 

♦Memoirs of the Med. Society, London, vol. v. 
•(•North of England Med. and Surg. Jour., Aug. 1830. 



1836. J Influence of different Professions on Consumption. 





St rcl- Grinders. 


Oilier trades. 


"Above 30 years 


125 


140 


:35 


83 


11H 


40 


40 


92 


45 


24 


70 


50 


10 


56 


55 


4 


84 


60 


1 


19 



287 :m 

" This table shows how much steel grinding abridges the lives of tho 
workmen engaged in this occupation. Numerous attempts have been made 
to render this operat : on less injurious, but all have been inadequate, and 
the grinding of steel is at the present moment as hurtful to the health of 
the workmen as it was thirty years ago." 

The inhalation of silicious or calcareous particles is also injurious ; the 
former much more than the latter ; the inhalation of light filamentous sub- 
stances, as cotton, flax, hemp, is also very injurious, owing probably to 
their flexibility, and the ease with which they may thus be introduced far 
into the bronchi. The practical importance of these facts is evidently 
great. We will give the author's conclusions in his own words : 

" Reviewing, meanwhile, the preceding facts, we arrive at the following 
conclusions. 

"I. The circumstances which multiply cases of consumption are, indi- 
gence, a sedentary life, and the absence of muscular exercise, the concussions 
of the workshops, the bent posture, the impure air of shops and manu- 
factories, the inhalation of certain mineral or vegetable vapours, and lastly, 
air loaded with powders, coarse or impalpable, or with bodies light, elastic, 
and filamentous. 

"2. The circumstances which exercise a preservative influence are, 
opulence, an active life spent in the open air, the regular exercise of all 
parts of the body, the inhalation of aqueous vapours, or of animal or vege- 
table emanations. 

" But it is not enough to specify these different circumstances. It is 
requisite to estimate the degree of influence of each in the production of 
consumption. The following table, which gives the mean number of con- 
sumptive persons among the workmen exposed to these several influences, 
will serve to determine this question : 

Mean number of Consumptive cases 114 per 1000. 
1. Noxious Influences. 

1. Mineral and vegetable emanations, 0,177 

2. Various sorts of powders or dust, 0,145 

3. Sedentary life, 0,140 

4. Life spent in shops or manufactories, 0,138 

5. Hot, dry air, 0,127 

6. Bent posture, 0,122 
^. Motions of the arms causing shocks of the chest. 0,110 

2. Preservative Influences. 

1. Active life, (muscular exercise,) 0,080 

2. Exercise of the voice, 0,07.") 

3. Life spent in the open air, 0,073 

4. Animal emanations, 0,000 

5. Aqueous vapours, 0,053" 
Thus the most hurtful circumstance to the lungs is the inhalation of sun- 
dry mineral and vegetable emanations; and the most important prophylactic 
influence is the inhalation of aqueous vapour. 

The author makes the following hygienic and therapeutic applications of 
fhe foregoing facts : 



126 New and successful remedy for the Croup. i_JuIy> 

1. That from the influence of these circumstances in the production and 
prevention of this disease, it may be inferred that consumption is the result 
of general disease, and is not a primary local affection of the lungs; and 

quently, in attempting a cure our means must be general. 

2. The rarity of consumption among sick-nurses and infirmary servants, 
shows that there is but little foundation for the belief that the disease is 
contagious* 

3. Attention to ventilation is of the highest importance in this disease. 

4. The moisture in the atmosphnre exerting such a remarkable prophy- 
fact ic influence in this disease, we should, in selecting a climate favourable 
to consumptive persons, take the moisture of that climate into consideration ; 
and workmen liable to be exposed to hot, dry air, should use means to 
secure the presence of aqueous vapour in their shops. 

5. Exercise of all parts of the body should be taken by all persons engaged 
in sedentary pursuits, who wish to prevent consumption ; and 

6. A judicious change of trade or occupation should be recommended by 
the physician in suitable cases. 

Comment on this memoir were useless. Every reflecting physician will 
at once see its valuable practical application; and although M. Lombard 
differs in a few circumstances from others who have investigated the same 
subject, and possibly may be in error in some unessential particulars, yet, 
the extent of his examination, and the ability with which it has evidently 
been conducted, should ensure to the author of this valuable memoir, the 
belief of his readers in his main and important conclusions. R. P. 

Trans. Jour. Ed. Med. and Sur. Jour. <fyc. 



New and successful remedy for the Croup. — In the following note, from J. 
D. Fisher, M. D. of this city, he speaks of a new and successful mode of 
treating that alarming disease of childhood, the croup, which ought to be 
made known through the newspapers, wherever they circulate. Should 
subsequent observation establish the fact of the superiority of the rein; dy, 
Dr. Fisher deserves to be remembered in the first class of public bene- 
factors. 

My Dear Doctor. — I was called, at five o'clock last evening, to a child 
which was laboring under a severe attack of the croup, consequent upon 
a sudden disappearance of the eruption of meaz'- s. The croupy symptoms 
appeared suddenly, and had existed one hour before 1 was called. The 
child, on my arrival, was in extreme agony, struggling and gasping for 
breath; and I thought the little sufferer was in danger of immediate suffo- 
cation. The first means I employed was the application of very hot, 
almost boiling, water to the throat and upper part of the chest, by means of 
large sponges. These applications I repeated every two minutes, and 
immediately the skin became coated and red, and in the course of a quarter 
of an hour the little girl breathed much easier, and her croupy cough and 
respiration became less shrill and tubular, and much modified. Soon ;f r 
making the first application of the sponges to the throat, I wrappetk'he 
child in a woollen blanket, wrung out in hot water, as a substitute Tcr a 
warm bath, and gave it twenty drops ol the wine of antimony in a little 
sweetened water, which she swallowed with difficulty. I persevered in the 
applications of the hot moist sponges for an hour, when the child wrs so 
much relieved that I ventured to leave it for half an hour — ordering the 
remedy to be continued. On my return, I found the patient br< ;ith v d 
with comparative freedom, its respiration and cough less sonorous and 
shrill, and its pulse softer and more natural. I recommended the applica- 
tions to be continued until the child should be decidedly relieved, and pre- 
acribedsix drops of ant.imonial wine to be given every hour in a little 
water. The mother of the child informed me, this morning, that she- 



1836.] Recovery from Asphyxia in a new horn Infant. 129 

continued to apply the hot-water remedy for five hours, but not so often 
as I applied them — that the child continued to improve, and foil asleep soon 
after 1 left it. This morning she is bright and playful, and asks for food. 
Tne respiration is quite easy — pulse soft and natural — cough humid and 
loose — its sounds having lost the shrill croupy character. 

I was induced to employ the above remedy, in consequence of having lately 
read m a foreign journal, that it had been suggested and employed by a 
German Physician with decided and uniform success. As the remedy is 
simple, and is at ready command, and as its application in the present case 
was attended with such decided and immediate happy effects, I would with 
a good deal of confidence advise mothers and nurses in similar cases to 
apply it early and perseveringly until medical aid can be obtained. The 
sponges should be gently squeezed before they are applied, so that the 
water shall not oosv from them, and should be gradually compressed du- 
ring the time they are applied, so as to continue the temperature up to the 
highes*: degree that can be sustained by the patient. Should sponges not. 
be at hand, napkins wrung out in the boiling water may serve as good 
substitutes. — Tram. Jour. — Bost. Med. and Sur. Jour. 



Recovery from Asphyxia in a new born infant. — The follow- 
ing case, very remarkable and interesting from the length of 
time animation was suspended, has been communicated to the 
Edinburgh Medico-Chirurgical Society, by Dr. MacWhirter, 
and is contained in our esteemed Edinburgh contemporary for 
January, 1835. 

" I was called, at about half past 11, P. M., to a lady who 
had been several hours in labour. I found the os tincce expand- 
ed to the extent of a crown piece ; the membranes pressed for- 
ward by every pain, and the presentation ' breech,' pain recur- 
ring regularly and forcibly every four minutes. About a 
quarter before one, the membranes gave way, the liquor amnii 
was discharged, and the labour, which was a iirst one, advanced 
slowly, until half past one, when the breech was born. Sus- 
pecting that resuscitation would be necessary, I desired the 
nurse to have warm water at hand. The body and head were 
long in transitu ; the funis was round the neck twice ; I disen- 
gaged it, but could feel no pulsation. I got my fingers into the 
mouth of the foetus, and succeeded in bringing it beyond the 
verge of the perineum, but it did not breathe. In about ten 
minutes, by management and the uterine action, the head was 
delivered, and along with it the placenta. 

" The infant appeared dead ; indeed, it was thrice felt con- 
vulsed in transitu. The face was white as paper, but there 
was some colour in the lips ; still no pulsation of the heart 
could be felt. 

" I placed the child, with the placenta attached, in a warm 
bath ; gently inflated its lungs with my own breath, in the usual 
way ; rubbed brandy on the chest, abdomen, head, spine, ex- 
tremities, &c. As the funis when cut did not bleed, 1 therefore 



128 Acute fain in the Vagina after delivery, §c. [July, 

tied it. After immersion of about half an hour, I took it out of 
the bath ; dried, and wrapped it in a warm flannel, and made 
the nurse carry it near the fire. I then continued the gentle 
inflation from time to time, and the spirituous friction, to the 
extent of nearly two bottles of brandy and whiskey, occasion- 
ally slapping the bottom, when at length, about forty or fifty 
minutes after birth, it gave a sob. This was indicative of ex- 
isting life, and encouraged me to persevere. It continued to sob 
or gasp at intervals of a minute or two, and I now found that I 
could feel the heart beat. 

" The above mean's were most perseveringly continued, until 
the circulation and breathing very gradually increased. At the 
end of an hour and a half, the child gave a whimper ; the 
eyes opened ; the lips became red ; it breathed regularly ; cried 
lustily. It lived and continues to live. — Am. Jour, of Med. Sci. 



Acute pain in the Vagina after delivery. — Dr. Chopin, in an 
an article in the Gazette Med. de Paris, (31st Oct. 1835.) states, 
that shortly after delivery, and especially of first children, he 
has discoved on the posterior surface of the vagina of the mother, 
small excrescences of the size of a grain of wheat, rarely of the 
size of a small pea, and of a deep red colour. They are easily 
recognized by their saliency, their exquisite sensibility, and their 
deeper colour than that of the vagina. The pain attending 
them, he describes as more insupportable than that of labour. 
His patients describe it as that of a hot iron in the vagina. He 
says that the pain is relieved by the application of lint, dipped in 
chloride of lime, to the tumours. — Am. Jour. 



Early Impregnation in the Cow. — A writer in the London 
Lancet states that recently a bull calf less than three months 
old, and a quay calf of about two months, copulated ; and 
within nine months the female brought forth her first born — 
she and the offspring being yet alive. In the Veterinarian, one 
case is related in which impregnation took place in a calf of six 
months, and another at four months. Boston Med. and Sur. 
Jour. 



Neuralgic Pains in the Stomach. — The new article creosote 
has been em ployed in London in the treatment of spasmodic 
and neuralgic pain of the stomach. The dose was gradually 
increased to seventeen minims every four hours, which entirely 
removed the pain, and cured the patient. — Ibid. 



SOUTHERN MEDICAL 



AND 



SURGICAL JOURNAL 



Vol. L] AUGUST, 1836. [No. 3. 



Part I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Acupuncture as a remedy for Rheumatism. By Wm. Markley 
Lee, M. D. of Indian Town, S. C. 

Few diseases are reported to be cured by a greater variety 
of remedies than Rheumatism, and few are subject to greater 
disappointment in the attainment of the expected results. This 
arises principally from the circumstance, that Rheumatism is of 
a two-fold character, entonic and atonic, requiring the closest 
discrimination in treatment, as the remedies proper for each 
form are diametrically opposite in their action. 

The detail of all the remedies for Rheumatism would occupy 
much space, and convey little new information. My present 
object will be, to give my experience in the use of one remedy, 
in my opinion not sufficiently appreciated. It was about six 
years since, after reading the practice of Churchill, Cloquet, and 
others, I was induced to try this remedy on my patients, in 
cases apparently suited to it, and, for the sake of brevity, will 
give a sketch of a few of these cases. 

Case I. I saw an old negro woman, the gardener of one of 
my friends, limping at her work, who, on enquiry, stated that 
she had Rheumatism of the knee. I had not at that time tried 
acupuncture, but feeling disposed to make the experiment, told 
her in a jocular manner, that I could cure her with a needle ; 
to this she was extremely averse, fearing the pain, but after 
17 



130 Acupuncture as a remedy for Rlieumatism. [Aug: 

some persuasion consented. Having lined the larger end of 
two slender needles into small phial corks, 1 kept the skin of the 
inner surface of the knee tense with the thumb and lore finger 
of the left hand, and introduced them to a moderate depth with 
a slow, alternate, semi-rotary motion. As their points entered 
the skin, she complained of slight pain, which being pierced, she 
scarcely felt them : after about ten minutes, I directed her to 
bend the knee slowly : to her surprise, flexion no longer caused 
pain, as it did previous to their introduction. The needles were 
then withdrawn with the same motion as inserted ; not a drop 
of blood was lost ; even the places of insertion could not be 
seen, and what was infinitely more important, the pain had 
vanished. A few minutes after, she complained of it at the 
inner side of the ancle, whence, after about the same lapse of 
time, it was routed as from the knee. The old woman was so 
delighted that she danced for joy. For several days, she con- 
tinued free from her old complaint, but after being again expo- 
sed to the exciting cause, damp weather, it was renewed. The 
experiment was not repeated. 

Case. II. A lady was subject to Rheumatic stiffness of the 
neck, after exposure to a damp atmosphere, particularly at 
night. On one occasion I found her with her head so fixed, that, 
rotation was impossible. After some persuasion, she consented 
to the introduction of the needles ; of which two were inserted,, 
one on each side of the vertebra?. As their points touched the 
posterior fasciculi of cervical nerves, she complained of an acute 
tingling sensation, like an electric shock, which induced me to 
retract the needles slightly. After about fifteen minutes, I re- 
quested her to make an effort to turn her head, which to her 
surprize she did, with no pain except that which arose from the 
pressure of the muscular fibres upon the points of the needles. 
The relief was prompt and permanent. 

Ca*e III. I had the misfortune some years since to luxate 
my left clavicle, in consequence of which I have been occasion- 
ally subject to rheumatism of the deltoid muscle on getting wet. 
I have in repeated attacks, laid bare the shoulder, and requesting 
some friend to keep the skin tense, introduced three needles 
around the shoulder. Previous to their introduction, I could not. 
raise the arm to a horizontal direction, unless aided by the other 
hand, and suffering severely. The pain caused by the needle 



1836.] Acupuncture us a remedy for Rheumatism. 13J 

inserted into the anterior fibres of the muscle, was decidedly the 
most acute, evidently arising from the contiguity of the nerves 
which supply the arms. In fifteen minutes I was free from 
pain, and could move the arm with perfect ease, upon which 
the needles were withdrawn. Months elapsed before I expe- 
rienced any return of the Rheumatism. 

Case IV. An old seaman laboured under entonic Rheuma- 
tism of the deltoid muscle ; the shoulder was sensibly hot, but 
being a topical disease, at the request of the physician of the 
Marine Hospital, of which he was a patient, I consented to try 
acupuncture ; he, like myself, could not elevate the humerus to 
a horizontal direction. The needles were introduced, and suf- 
fered to remain two hours; extraction was found extremely 
painful and difficult ; the corks were detached, and it was 
accessary to thread the needles in order to extract them. Be- 
fore insertion they were highly polished ; after extraction they 
blackened and deeply corroded* completely around the 
on at the surface of the skin ; the imbedded portion, irre- 
gularly. It is well known that the nerves arc expanded as a 
delicate net-work over the entire surface of the skin ; it is also 
supposed that the nervous and galvanic fluids arc identically 
the same. May not the greater abundance of this galvanic or 
nervous fluid at the surface, account for this more complete 
corrosion of that part of the needle ? The pain w r as by no 
I r ins removed; indeed he suffered so much from the extrac- 
tion, that no persuasion could induce him to submit to any vari- 
ation of the experiment. He was subsequently cured by other 
means. 

Case V. A young man applied to me, to try the effect of 
acupuncture upon a chronic pain of the loins, which had been 
treated unsuccessfully by some of the most eminent physicians 
of Charleston ; cupping, blistering, rubefaciants having all been 
tried with only temporary benefit. On the insertion of the 
second needle, if I mistake not, he fell back into my arms in a 
state of syncope. Having laid him on one side, I extracted the 
needles. He stated, after reviving, that it was not pain, but a 

■* I recollect to have read in a French Medical Journal, to which I have 
not access at present, that the same effect (corrosion) was produced upon 
a needle inserted in a portion of flesh newly prepared for the table. Altho' 
rather incredulous, I repeated the experiment, and found the statement 
literally correct : the needle was furrowed, blackened? and excavated. 



132 Acupuncture as a remedy for Rheumatism. [Aug; 

sudden sickness, which caused him to faint. This uncommon 
symptom would have caused me some alarm, had I not pre- 
viously met with such a case in a French journal. I never 
could persuade him to repeat the experiment, although the 
lumbar pain was relieved for a few days. 

These are a select few of many cases of Rheumatism which 
I have treated by acupuncture ; — they have led me to anticipate 
the following results, viz. 

In acute Rheumatism, the needle acts as an irritant, and is 
therefore improper before inflammatory action has been reduced. 
The effect produced in case 4th, will be a lesson to me in future 
never to suffer the ordinary steel needles to remain for any 
length of time. Under those circumstances they should be made 
of gold or platina. 

In sub-acute Rheumatism, I consider acupuncture a prompt 
and efficacious remedy. I frequently employ it, much to the 
surprize of my patients, from the trifling pain which it causes, 
and the promptness of relief; and equally to the astonishment 
of the attendants, who rarely have faith in the remedy, until 
proved by positive demonstration. 

In chronic Rheumatism, acupuncture will relieve promptly 
and thoroughly, but the disease is liable to recur on the re- 
application of the cause usually producing it. 

It may be inferred from what has been stated, that I believe 
acupuncture to owe its efficacy to the transmission of the gal- 
vanic fluid. Such has long been my opinion, although I had no 
opportunity to ascertain the fact by the use of the battery. 
This point has been recently established by the experiments of 
Dr. Stokes, of the Meath Hospital, as re-published from the 
London Medical and Surgical Journal into the American Jour- 
nal, No. XXXIII, p. 225, et sequent. As this periodical is in 
general circulation, the reader will find the article referred to. 

1 consider acupuncture entitled to far more attention than it 
has yet received in the United States. It is not painful. I 
have never introduced the needle without the patient expressing 
the greatest surprize at the trifling degree of pain ; indeed some 
have declared that if asleep it would not awake them. Of this I 
have some doubts. // is not inconvenient. Every house can 
furnish needles. It is prompt and effectual. I have never failed 
to produce the desired effect, in appropriate cases, within the 



1830.] 



Meteorological Observations. 



133 



space of a quarter of an hour ; and in such cases, the relief was 
permanent. I therefore repeat it as my opinion, that physicians 
have not duly appreciated its therapeutical efficacy. 



ARTICLE II. 



Meteorological Observations for Burke and Richmond counties., 
Extracted from the Journal of a Geological Survey. By 
Professor J. M. Cotting. 



MAY. 
Greatest heat at 12 o'clock, - 

Least heat at do. - - ' - 

Mean heat of the first half of the month, 
Mean heat of the last half of the month, 
Mean heat of the whole month, - 
Rain Guage, 2 inches, 6 1 

Cloudy days, 6 

Thunder showers, - - 17 

JUNE. 
Greatest heat at 12 o'clock, 

Least heat at 12 o'clock, - 

Mean heat of the first half of the month, 

Mean heat of the last half of the month, 

Mean heat of the whole month, - 

Rain Guage, * 7 inches, 

Rainy Days, - 9 

Thunder showers, - - 10 

Prevailing winds, S. E. and SW. 

June 20. First general appearance of blossoms on cotton on 

many plantations in Burke county. Though in small patches, 

in situations exposed to the sun, some blossoms were observed 

as early as the 12th of the month. In all these latter situations, 

the soil, by analysis, was found to contain from twenty to thirty 

per cent, of lime, and much animal and vegetable decomposed 

substance. 

Note. The diurnal mean heat is obtained from a number of observations 
made during the day ; the monthly and semi-monthly is deduced from the 
diurnal means. 



sr 

63 

64.25 

74.62 

63.91) 

■2 lines. 



90° 
58 

71.22 

75.09 

71.61 

7 lines. 



13-1 Case of extensive fracture of the Cranium. [Aug. 



ARTICLE III. 

Case of extensive fracture of /he Cranium, with injury of the 
Dura. Mater ana' loss of Brain. By John M. Anthony, 
M. I), of Augusta, Ga. 

On the 9th of March, 1834, at 11 o'clock, A. M. a servant 
boy belonging to Mr. Carswell, of Burke county, was found in 
the stable, in a profound stupor, and apparently insensible to 
all impressions. I visited him at 9 o'clock, P. M. of the same 
day, still labouring under the same symptoms, with very slow 
respiration and pulse, a considerable swelling over the left ear, 
with a wound in the integuments, about the size of a buckshot 
hole, from which some blood, and a small quantity of cerebral 
matter had been discharged, evincing subjacent fracture of the 
bone, and breaking up of the cerebral mass. 

The patient remained in this situation until the forenoon of 
the 10th, when Dr. M. Antony met me in consultation on the 
case. We soon proceeded to a farther investigation of the in- 
ternal condition of the wound by the knife ; whereon, when we 
raised the flaps, which were made by an incision through the 
integuments, commencing between the zygomatic process and 
the auditory foramen, and extending up on the parietal bone : 
and one transversely above the ear; the fracture of the cranium 
Was fully brought to view. It extended from the posterior 
inferior angle of the parietal, passing just over the zygomatic 
process to the temporal portion of the sphenoid bone. This part 
of the fracture was of a curved shape, with its convexity down- 
ward. An inch and a half above, there was a similar fracture, 
though less curved, chiefly in the external plate of the parietal, 
corresponding in direction with the first, with which it united 
anteriorly and posteriorly. The depressed part consisted of 
many fragments of different sizes, most of which remained at- 
tached to each other, and to the upper part of the fracture by 
the inner table, which, instead of breaking, had bent under the 
violent force which caused the fracture, (which we believed to 
be the kick of a horse,) the separation being complete only 
throughout the whole extent of the lower side of the fracture. 



1836.] Case of extensive fracture o) the Cran 135 

After removing some loose spiculae* we attempted to elevate 
the depressed fragments to a level with the general surface ; but 
in consequence of their haying been driven beneath the firm 
bone ait the lower side of the fracture, we could no 
notwithstanding a considerable lever power was used. »W« 
then resorted to the use of the saw, by which, division of the 
inner table was completed through the whole extent of the 
upper, anterior, and posterior limits of the fracture. 

The fragments were then easily raised, immediately on ac- 
complishing which, the patient uttered a loud shriek, and there 
gushed from the wound about two large table spoonfuls of cere- 
bral matter, slightly and irregularly coloured with blood ; so as 
to represent a thick, bloody, purulent discharge from a suppu- 
rating depot. It seemed to be that portion of the brain which 
had been broken up by the violence which had driven the whole 
of the depressed parts deeply into that organ, as they moved 
widi a hinge-like attachment to the upper edge of the fracture ; 
and from which depression the resistance within Had forced 
them back to lodge against the inner table below. The Dura 
Mater was lacerated through nearly the whole autero*posterior 
length of the fracture, on a level with the lower part ; from 
about the middle of which, so soon as the pressure of the frag- 
ment beneath was removed, a brisk arterial haemorrhage came 
on, which, however, soon ceased spontaneously. The wound 
being cleansed of all loose spicuke, saw-dust, &c. the integu- 
ments were laid on the wound and secured by adhesive straps, 
suitable compress, bandage, &c. leaving sufficient vents for dis- 
charge. During the progress of the operation, considerable 
re-action came on, and the sensibilities returned to a considera- 
ble extent. On the morning of the 11th, his sensibilities were 
very well restored ; but the power of speech had not been ftdly 
recovered. His pronunciation was not very distinct ; but he 
endeavoured to use some words — mostly verbs ; but never 
seemed to attempt the pronunciation of any noun. It appeared, 
indeed, that he had no memory of the name of anything what- 
ever. He continued to do well until the 14th, when some 
spasms of the same side of his face and jaw appeared, and 
lasted about twenty minutes. In the evening they re-appeared, 
and were finally dissipated by an anodyne. On the morning of 
the 15th. a yellow serous discharge issued from the wound; 



136 Ca$ of extensive fracture of tlte Cranium. [Aug. 

lho collection of which had probably caused the spasms of the 
previous day. This discharge continued for several days, du- 
ring which he gradually recovered his speech ; and with the 
suitable use of means for preserving a due solubility of bowels, 
lie was well at the end of six weeks. 

The January following, the boy was attacked with symptoms 
of Phrenitis, which readily yielded to the early application of 
the lancet, and of cold water to the head. 

It may be well to state in this place, that at the time he 
laboured under Phrenitis, Pneumonia was so prevalent that 
twelve other members of this family were suffering from it. 

This boy had received, several years previous, an injury of 
his head by a fall from a horse, which rendered him liable to 
suffer much from exposure to great heat of the sun — from 
which, indeed, he was, at one time, so much afflicted that a 
serious *and protracted course of treatment was necessary for 
his restoration from considerable derangement of intellect. In 
general, however, these turns were characterized by headache, 
red eyes, &c. of which he was usually relieved by a purgative, 
with abstinence. 

Since his recovery from the fracture of the cranium, he is no 
more liable to danger from exposure to the sun ; but sustains 
as much exposure as other persons without the least inconve- 
nience. 

Note. This fracture was remarkable for the extent of injury- 
There were ten fragments of bone removed, three of which 
were about an inch and a half long, and one-half to three-fourths 
of an inch wide ; the others of different smaller sizes. But the 
chief importance of the case is the extent of injury of the mem- 
branes, the extent of violence done to the cerebral mass, and the 
large quantity lost, from which there was recovery. It is also 
remarkable that the old morbid condition from a former wound 
was cured by this. There is another observation, however, on 
this case, which I think of more practical importance. On 
contemplating the seat and extent of this injury, it will be seen 
that the cerebral substance of the middle lobe was broken up 
and compressed into almost the whole range of the great infe- 
rior horn of the lateral ventricle. There was consequently an 
undue pressure on all the parts of the cerebral mass bounding 



1836.] Case of extensive fracture of the Cranium. 137 

this part of this cavity ; through the whole extent of which is 
the relief known by the name of Coram Ammonis. This pres- 
sure continued with very considerable force until the bone was 
liberated; as evinced by the sudden gush of broken cerebral 
matter immediately on relieving the pressure. At this time, 
too, it will be remembered that his sensibilities became very 
considerably improved, and he soon recovered the memory of 
many words. The serous effusion into the wound continued a 
considerable pressure on these parts until it escaped freely, 
several days after the dressing. During the whole of this 
time, the loss of the memory of nouns continued — things them- 
selves were remembered, their qualities, &c. understood ; but the 
name in no instance during my observation of the patient ; and 
-as I understood, at no other time, until after the serous discharge 
from the wound, above alluded to, when the power of using 
nouns returned. Even personal pronouns were remembered. 
We will illustrate his speech by an example. On desiring 

coffee, he said " Give me some give me some ." On 

b^ing asked what ? he said ?' some " putting his finger to 

his open mouth. Some water? "No." Some tea? "No, 
some ." Some coffee ? " Yes." 

Some three or four weeks after witnessing this case, I visited 
a lady in a neighbouring village, who was labouring under pre- 
cisely similar derangement of the power of speech. On my 
arrival, she soon desired some water. Her expression was 

" give me some ." Water ? " Yes." On finding that 

her husband had left the room, she enquired, "where is my 

," repeatedly, until her husband returned. I was informed 

that on desiring that I should be called to her, she said, " send 

for away yonder," pointing towards Augusta. On 

naming several physicians to her, she said " no," until my name 
was called, when she replied, " yes." The messenger had not 
been long despatched before she manifested a want of recogni- 
tion of time, in relation to the distance to be travelled, a distance 

of about fifty miles, by asking, " Is coming ?" " Has 

come ?" On being asked what or who she meant, she 

would reply, " Has come from away yonder ?" 

pointing towards Augusta, &c. &c. 

The lady had a few weeks before taken cold, on the third day 
of her childbed confinement, the effects of which appeared to 
1% 



138 Case of extensive fracture of the Cranium. [Aug, 

have been considered as milk fever. The febrile symptoms,, 
however, continued ; with intense and increasing pain, near the 
lower part of the middle lobe of the cerebrum. Various pre- 
scriptions had been used with little or no good effect. The 
febrile action had gradually moderated, the skin continuing dry — 
secretions generally torpid, with pale hydropic expression, &c. 
Remembering the late demonstration of pressure in the same 
part of the cerebrum, in the above case, which was called to 
my recollection by the precise similarity of nomenal dementia 
or hebetude, I was induced to offer the opinion to the consulta- 
tion, that there was undue pressure on the same parts of the 
cerebral organ. The history of the whole progress of the local 
inflammatory action which had been manifested, about the lo- 
cation of that part of the choroid plexus which extends down 
into the inferior horn of the lateral ventricle ; the present aspect 
of continuance, the remaining febricula, and the evidence of 
pressure within this part of the ventricle, induced me to offer 
the farther pathological view that the inflammatory action was 
terminating by an hydropic effusion into this cavity, which ex- 
erted the pressure. 

A therapeutic course in strict relation with these patholo- 
gical views, was adopted, on which the patient recovered in a 
reasonable length of time for a case so chronic in its nature. 

The sensation of pain in this case had pointed out very pre- 
cisely the location of that part of the ventricle above alluded to- 
and the whole of that part of the choroid plexus which extends 
into the inferior and the posterior cornu of the lateral ventricle. 

These observations may be useful in Phrenological enquiries 

M. ANTONY 



1830.] An Essay en Idiopathic Fevers. 130 



ARTICLE IV. 



An essay in answer to the question " are there any idiopathic 
fevers ?" — read before the Medical Society of Augusta. By 
Edward A. Eve. M. D. of Richmond county, Geo. 

Befpre entering on a subject, the discussion of which has for 
a considerable time, more warmly than any other, occupied the 
medical world, and which still remains " sub judice ;" it may be 
well to come to a precise understanding of the terms used. 
The strictly lexicographical definition of the word Idiophthic, 
would be a peculiar affection, from «W (peculiar) and tfaAog 
(an affection). In a more medical sense, it would denote a dis- 
ease independent of any other disease ; it seems, however, to be 
used more particularly by medical writers, with reference to 
the antagonal position it bears to the term symptomatic. It is 
considered that in -this relation, the power of the term seems 
most obvious. With these views, from the amount of evidence 
that presents itself to my mind, I am compelled to believe that 
there are fevers which may be properly entitled idiopathic. 
Although, in a certain limited sense, fever may depend upon 
local irritation, still I would not recognize by this the doctrine 
that all fevers radiate from a local point of irritation, much less 
that the " cohors febrium magna" (all the infinite diversity of 
fevers,) depend on a pre-established gastro-enteric inflammation. 
While we willingly accord to Broussais the honor of being one 
of the greatest pathological writers of the present age, still we 
regret to see, that, that saliency of genius, which, like " vault- 
ing ambition overlaps itself" has led him far, very far into ul- 
traism, the besetting sin of the day ; and while we acknowledge 
that he has unmasked many hitherto occult gastro-enterites, and 
by a more enlightened pathology, conducted to a better and 
more judicious treatment, thereby conferring a lasting obligation 
on our science, still we must urge against that doctrine, the 
charge of too great exclusiveness, which attributes all fevers to 
a pre-established inflammation of the stomach and intestines. 
I am aware that in supporting the side of the question, which 
the preponderance of evidence compels me to advocate, I shall 



140 An Essay on Idiopathic Fevers. L^ u o- 

oppose the opinions of some members of this society, whose 
medical attainments I hold in very high estimation. 

The advocates of the Broussaian doctrine refer to post-mortem 
examinations, and believe the truth of their doctrine established 
by the phenomena developed by the dissecting knife. It is affirm- 
ed that traces of inflammation in a more or less advanced state, 
occur almost universally in the mucous membrane of the ali- 
mentary canal of such patients as die of febrile affection. Ad- 
mitting that these marks of previous inflammation do very ge- 
nerally occur, it is reasonable to suppose, that in a very great 
many cases, inflammation of this part, instead of being the 
original- source of the disease, supervened after the develope- 
ment of febrile action : that parts unaffected in the commence- 
ment of fever, do in its progress become highly affected with 
inflammation, is a fact of familiar observation, and when we 
bear in mind, that the secretions poured into the intestinal canal 
are vitiated, and sometimes of a very acrid quality; and more- 
over, that from the almost entire proscription of purgatives so 
strangely insisted on in the Broussaian practice, they are allowed 
to remain an unmerciful length of time in contact with the de- 
licate mucous membrane of the intestines ; is it strange that tra- 
ces of inflammation, or even of ulceration should appear ? As 
a still farther offset against evidences drawn from autopsic ap* 
pearanccs, it is ascertained that so far as a mere redress, or an 
injected state of the capillaries of the mucous membrane is con- 
cerned, no satisfactory evidence can be adduced of the previous 
inflammation of this structure ; for these phenomena often oc- 
cur in articulo mortis or post mortem; as has been demonstrat- 
ed by the observations of Yellowly and Seeds, founded on expe- 
riments. The former of these writers observes, that from see- 
in" these appearances of the stomach so generally exist, in 
persons suddenly destroyed, while apparently in perfect health, 
in whom he found the mucous membrane of the stomach highly 
injected, he is induced to imagine that the opinion so usually enter- 
tained of their being the result of inflammation is not well founded. 
Drs. Seeds and Parish found that in animals bled to death, the 
membranous structures frequently exhibited a state of injection, 
which might readily be mistaken for inflammation; this may also 
be accounted for by a power the arterial tubes have of contract- 
ing to a considerable extent, by what Bichat calls the contract;"- 



1836.] An Essay on Idiopathic Fevers. \ 11 

lity of texture, and that this power is not limited to the period of 
life, but continues for some time after death. It is equally a 
physiological fact, that the capillaries are endowed during life, 
with a peculiar kind of sensibility, which causes them to resist 
the intromission of such fluids, as they are not, in the perform- 
ance of their natural functions, designed to convey. This. pecu- 
liar sensibility, by virtue of which, the serous capillaries refuse, 
or contract against the intromission of red blood, it is thought, 
depends on the regular influx of the nervous influence. These 
facts are abundantly proven by experiments made on animals. 
The following is one of M. Bunira's, quoted by M. Bichat : — 
He fixed the pipe of a syringe into an artery of a living ani- 
mal, and on endeavouring to force the fluid into the vessel, he 
found great resistance, the piston passing very slowly, and only 
with the application of much force. On causing the animal to be 
killed, by dividing the spinal marrow just below the occiput, the 
fluid passed rapidly out of the syringe into the artery, although 
very little force was applied. The application of the result of 
this experiment to the post-mortem production of a red and in- 
jected state of the membranous structures, is easily explained. 
So long as the serous capillaries retain their vitality, they resist 
the entrance of red blood ; as soon as their vital properties 
cease, they lose the power of resisting the intromission of red 
blood, becoming in fact mere yielding and passive tubes : and 
as the arteries continue to contract on their contents for some 
hours after the extinction of life, they necessarily force the red 
blood forward into the now relaxed and unresisting capillary sys- 
tem, and thus is produced the red and injected state of the more 
vascular structures so often found on post-mortem examination, 
where no previous inflammation whatever existed. Sir W. Philip 
found that the lungs and stomach were covered with injected ves- 
sels in animals, which died from the division of the par vagum. 
Yellowly found that persons who died from hanging, exhibited 
the mucous membrane of the stomach in a high state of apparent 
inflammation. And the able Professor of Anatomy in this College, 
while conducting the post-mortem examination of the last cri- 
minal executed in this county, exhibited to the admiration of 
all present, a most beautiful specimen of injected stomach. This 
individual it was well known died of hanging, and not of fever. 
If then this state of the stomach can, and does exist without fe- 



11:2 An Essay on Idiopathic Fevers.. [.Aug. 

ver being its attendant, and it' post-mortem examinations offe- 
rer patients show equal traces of inflammation in other organs 
of the body, as the brain, and thoracic viscera, it must in a great 
measure abate the value of the evidence afforded by the dis- 
secting knife in favor of gastro enteritis being universally the 
first link in the catenation of febrific causes. Another evidence 
oi the unsettled state of this doctrine may be predicated on the 
fact that the advocates of fever radiating from a focal point of 
irritation, locate that point in different organs. While Brous- 
sais pronounces gastro enteric inflammation to be the " fons et 
origo" of fever, the distinguished Clutterbuck, with equal confi- 
dence asserts that all fevers emanate from a pre-established in- 
flammation of the brain and its membranes ; and each appeals 
to post-mortem examinations for the the truth of his posi- 
tion. 

A consideration of a few of the phenomena of fever will per- 
haps reflect some light, by which we may distinguish idiopathic 
fever from the febrile action consequent on inflammation. With- 
out regarding the initial symptoms which usher in almost all 
purely febrile affections, and which are very different from those 
characteristic of inflammation, the whole course and phenomena 
of intermittent fevers present insurmountable objections to their 
identity with that febrile action consequent on a pre-established 
focus of irritation in the gastro-cnteric membrane. The course 
of treatment found most successful in the two diseases, will at 
once preclude the possibility of their identity ; while quinine, 
arsenic and piperine are the most successful remedies in arrest- 
ing intermitting fevers, who would not turn away with horror 
at the idea of pouring such phlogistic articles into the stomach 
of a patient labouring under gastro enteritis, and in their stead 
prefer leeches and the diete absolue. 

If we dislodge the origin of fever from the location assigned to 
it by Broussais and his disciples, it will be incumbent upon us to 
give it a habitation elsewhere ; we would therefore define fever 
to consist essentially in a nervous derangement of the arterial 
system, caused by the impression of a specific poison, designated 
malaria, arising from the decomposition of organic matter. — 
This derangement of the nervous, is imparted to the vascular 
system ; hence we have the first and second link in the forma- 
tion of a fever. A consideration of the manner ia wliich the 



1830.] An Essay on Idiopathic Fevers. 143 

febrile poison is communicated to the system, will, perhaps, in 
some measure countervail the opinion that it is altogether of 
gastro enteric origin, and tend to corroborate the positions ad- 
vocated in the preceding remarks. It is well known that fever 
depends upon a malarial constitution of the atmosphere. Those 
who contend for the gastric origin of fever, suppose that the fob- 
ritic poison becomes entangled in the saliva, and is thus applied 
to the surface of the stomach. The quantity received in this 
way, would scarcely seem sufficient for the effect produced. 
The very delicate and extended surface of the air-cells of the 
lungs, exposed to an impregnated atmosphere, would, it seems, 
present a much more adequate medium of communication. And 
when we reflect on the very extraordinary effect produced by 
the inhalation of the nitrous oxyde gas, as witnessed in the philo- 
sophic experiments of last Wednesday evening, we may well 
infer that opposite and deleterious consequences may be produc- 
ed more or less suddenly, by the continued breathing of a mala- 
rial atmosphere. Neither the nitrous oxyde gas, nor the sulphu- 
ric ether, will produce their peculiar exhilarating effects when 
taken into the stomach. 

Thus I have given in a rambling and desultory manner, as 
they have been suggested to my mind, a few of the evidences 
in favor of the existence of idiopathic fevers. The arguments 
on the other side of the question are many and specious, and 
well worthy of serious consideration ; but as we hope to hear 
them fully and ably advanced and advocated in the course of 
the evening, it will be unnecessary to offer them in this place. 

Before dismissing the subject finally, we will endeavor to de- 
fine in what fever really consists, and after this, institute a com- 
parison between it and inflammation ; by doing which, it seems 
to me, we may very clearly and satisfactorily disprove their 
identity. In defining the true nature of fever, we must consi- 
der what organs arc affected, in what manner they are af- 
fected, and in what order the derangements of these organs suc- 
ceed each other, " In fever there must be derangement of the 
nervous and sensorial functions ; derangement in the circulating 
function, and derangement in the secretory and excretory func- 
tions. This is the circle of morbid actions." Thus says Southwood 
Smith, to whom I am indebted for this definition of fever ; and the 
substance of whose lucid diagnosis between inflammation and 



I 1 1 An Essay on Idiopathic Fevers. I Aug. 

lever, I will proceed to give in a very condensed form, interlarded 
with such observations as will make it apply in the present dis- 
cussion. There never was a fever in which all these organs and 
functions were not more or less in a morbid state ; there never 
was a concurrence of this morbid state in this complete circle of 
organs without fever. It is not the invariable occurrence of a 
particular number of events that is alone sufficient to constitute 
fever ; to this must be added invariableness of concurrence in a 
particular order. Derangement in the function of secretion and 
excretion, never comes first in this series ; derangement in the 
nervous and sensorial functions never comes last in the series; 
derangement in the functions of the circulation never comes 
either first or last in the series, but ahvays second in succession. 
Thus fever consists in three successive morbid changes, occur- 
ring in the following order : — In the first place, derangement in 
the nervous and sensorial functions ; in the second, derangement 
in the circulating function ; and thirdly, derangement in the se- 
cretory and excretory functions. With the acknowledgment 
of these facts, w r e may dispense with symptomatology, as 
symptoms are only the external and visible signs of internal and 
invisible conditions of the organs. Thus having the true char- 
acteristics of fever, if no other disease presents the same charac- 
ter, fever must be a disease sui generis. In inflammation, 
some of the phenomena are the same ; but the order in which 
they occur is different, and thus affords a clear and applicable 
mark of distinction between fever and inflammation. In inflam- 
mation there is a similar derangement in the secreting and the 
excreting functions. There is also sometimes similar derange- 
ment in the circulating function, but the derangement in the 
nervous and sensorial functions is seldom, if ever, similar. The 
derangement in these latter functions, while it is apparently 
different in kind, is certainly and invariably different in the order 
of its occurrence. In Pneumonia, Enteritis, and Hepatitis, the 
nervous system is the last to be involved, and suffers the least. 
While we acknowledge that it is of the utmost importance in a 
practical point of view, to bear in mind the close connection 
between inflammation and fever, we at the same time see clearly 
that they are not identical. As the term fever is nrjeant to 
designate a certain number of events, which occur in a certain 
snries ; the term inflammation on the other hand, expresses ano- 



] 8 ;<i. j A cass <>f misplaced action of Ergot. 145 

tker series of events ; each event composing this train, succeed- 
ing each other in a different order* We have now compared 
infl immatioti and fever with regard to the series of events and 
the order in Which they occur in each, and find that they differ ; 
and as different terms are used to express different things, we 
conceive that the term idiopathic is a very proper word to 
designate such fevers, as we sec do not owe their existence to a 
pre-established inflammation in some [.articular organ. Although 
the state of the system in the primary attack of fever is not. 
identical with inflammation, it is acknowledged that the morbid 
condition into which the system is brought, in the progress of 
lever, is for the most part that of inflammation : still, even in a 
practical regard, though the remedies are the same in febrile as 
in ordinary inflammation, they must be modified in the same 
proportion that the febrile inflammation is modified by the pecu- 
liar pre-disposing and exciting causes. Venesection is equally 
necessary in each ; but the abstraction of sixteen ounces of 
blood in febrile, will effect as much as double the quantity in 
ordinary inflammation. Thus, though not for a moment deny- 
ing the abundant existence of symptomatic fevers, w r e insist, 
that, whether we observe the causes, the phenomena, or even 
the treatment of fevers, we are compelled to recognize also a 
'-lass which arc properly termed idiopathic fevers. 



ARTICLE V. 



.1 case of misplaced action of Ergot. By Isaac Bowex, M. D. 

of Augusta, Geo. 



- 



On the 17th of May, 1823, I was called to see a negro 
woman, who had been in labour for more than twelve hours. 
On examination per vaginam, the os tinea) was widely dilated, 
and the vertex of the child's head nearly even with the Labia. 
The presentation was strictly the first of Baudelocque. I 
arrived precisely at 4 o'clock, P. M. at which time I was 
19 



1 ii» A ease of nttsplacc^ action, of Ergot. L-^ u c- 

informed by a midwife then id attendance, that labour was 
going on very favourably until 12 o'clock, M. when the woman 1 
was taken with a cramp in the right hip, and labour pains ceased 
altogether. It will be perceived that she lay in this situation 
during four hours, only complaining with a pain in the hip. 

The case appeared to me one of the fairest for the administra- 
tion of Ergot. Accordingly, I made an infusion of twenty-live 
grains of this article, and gave it every fifteen minutes in broken 
doses. It was all given in about one hour and a quarter, pro- 
ducing no other effect than apparently to increase the pain in 
the hip, which became so excruciating as to require some device 
for a speedy relief. I ordered a brick to be heated, which was 
quickly done, w r rapped in a woollen cloth, and placed to the 
painful part. Almost immediately after this application was* 
made, the pain of the hip was relieved, and labour then recom- 
menced with unusual rapidity, and was terminated in a few 
minutes by the expulsion of a living child. I have seen Ergot. 
produce Asphyxia, in several instances, in which the pains were- 
not so violent. From all. the circumstances of the case, it wasp 
manifest to me that the action of Ergot was invited by the pain 
in the hip to assist in its increase. The same Ergot has been 
given since, in a great many cases, and has never failed to pro- 
duce labour pains in less than twenty-live minutes. In all 
other cases, in which I have seen it given where labour was 
partially suspended by erratic pafhsr, it seemed to rectify thee 
process by a direct actjon upon the uterus. 

Note. The facts of the above case oflaj&our, our favourable 
acquaintance with the author will not allow us for a moment to 
doubt. But under the guidance of our rule for philosophising, 
we feel bound to a different view of the sequence of phenomena, 
and conclude that the rationale is. 1st. That as regular labour 
existed; and 2d, a cramp or other severe painful affection. 
seized the hip ; that 3d, this cramp overruled the actions of re- 
gular labour ; and 4th, that when this overruling cause or 
influence was removed, the regular actions of labour were 
resumed, &c. 

The two first points are admitted. They are declared in the 
text. The third is supported by the fact of the proportion or 
adequatcness of the cause to the cfloct. as is proved by constant 



1836.] A case of misplaced action of Ergot. I4S 

demonstration of this proportional power. Who has not often 
witnessed the overruling of labour by spasms in the Lumbrici 

1 is, or the Gastrocnemian, or other muscles of the lower or 
upper extremities, or ether parts? Indeed much less powers, 
or those which appear less, are very common retarding influ- 
ences ; as bashfulness on the approach of the accoucheur, desire 
to evacuate, &c. One of the most provoking causes of retard- 
ation with which the accoucheur meets, (provoking because 
generally avoidable,) is the disposition of the patient to talk, or 
to change her position by voluntary effort at the approach of 
regular pain ; either of these being quite competent in most 
cases to the serious interruption of the progress. 

But there is another view of the proportion of cause to effect 
to be taken in this case, calculated to render doubtful the philo- 
sophy advanced. 

1st. The quantity of Ergot given Was very small, such as 
often fails to exercise a controlling influence on the case, espe- 
cially wh«.:n of such impaired power as that ordinarily procured 
of the druggists in the South for the last twelve or fifteen years. 

2d. It is the common tendency of Ergot to operate contrari- 
wise to this alleged operation — give point to the pains by pro- 
moting uterine action, and thus overrule what has been called 
misplaced labour. 

3d. Supposing the Ergot to have been better than usual, and 
the quantity well adapted to the susceptibilities of the system ; 
still the time, so far as we can form an opinion of it from the text, 
was not more than what was about necessary to develope the ef- 
fect of Ergot given thus moderately by the time the expulsory 
efforts became efficient, which was immediately after the warm 
application to the hip, the pain in which, from its intensity, hav- 
ing demanded " a speedy device for relief." 

The unusual rapidity of the labor, which " in a few minutes'* 
terminated m the expulsion of the child, was very like Ergot 
operation ; and if the article produced any effect itself what- 
ever in the case, it appears to us imst probable that it was in 
this part of the labour only. Ed. 



148 On Amygdalus Persica — Extract of Belladonna. [Aug. 



ARTICLE VI. 

On Amygdalus Persica — Extract of Belladonna. By M. 

Antony, M. D. Professor of Obstetrics, &c. in the Medical 

College of Georgia. 

Amygdalus Persica. (Lin.) Fol. Common Peach Tree. — I am 
not conscious of any difference in the medicinal powers of the 
numerous varieties of this species of Amygdalus, but have for 
many years used for their sedative powers the leaves of any of 
those varieties which w r e cultivate for their fruit. 

During the summer of 1831, after the prevalence of East 
winds for some weeks, a fever of unusual severity appeared here. 
These fevers were of remittent type, and rendered peculiarly fa- 
tal by their being generally attended with gastric irritation ; and 
indeed in very many cases, a high degree of gastritis and gastro- 
enteritis, with all their usual distresses and dangers prevailed. 
No symptom was so uniform, especially during the first half or 
two-thirds of the fever season, as a total inability to retain in the 
stomach the lightest article of diet, or most simple drink, with 
more or less tenderness of the epigastrium, on pressure. These 
distresses attended early with a sallow pallor, shrinking of fea- 
tures, and sometimes a pale leaden hue of skin, and general 
prostration. 

This state of the stomach at once, and as long as it continued, 
precluded all possibility of internal administrations, adapted to 
the treatment of bilious cases. Effervescing draughts — even a 
spoonful of cold water was often rejected. Sinapisms and 
Epispastics were used in vain. The state of stomach reminded 
me of some of those cases of plague in which this condition of 
stomach is a regular and troublesome symptom, and in which 
Laurel water has been found the chief corrective. Our 
Apothecaries could not furnish that article. Believing its vir- 
tues consisted mainly in the Prussic Acid which it contained, I 
determined to substitute it by some other article from which I 
could obtain the same power in a safe form, for ordinary use. 
For this purpose the Prunus Padus (wild Cherry) and Amyg- 
dalus Persica (common Peach) were presented to my mind. 
The latter being always at hand in every garden, I determined 



1 836.] On Amygdahs Persica — "Extract of Btftado n nd. 1 1 9 

on making my first experiment with it. The time for the petals 
had past. I filled a small vessel with the fresh leaves from the 
tree, loosely thrown in, then filled the vessel with boiling wa- 
ter and covered it closely. Of this infusion I gave * ss. every 
15, 30, or 60 minutes, according to the greater or less violence 
of the symptoms. I rarely, if ever, used the 4th dose before 
the distressing symptom was sufficiently removed to need no 
more. That acute — most distressing, distracting thirst, which 
called incessantly for drink, and was in many of those cases 
perfectly insatiable, was generally allayed with equal ease ; and 
although the taste of the infusion was most bitter and disgust- 
ing to the natural sense, in these cases it was' scarcely ever re- 
jected ; but on the contrary, called for most anxiously after the 
first taste of it ; even by children, to whom bitter drugs are gen- 
erally so offensive. 

I frequently applied to the epigastrium also with good effect, 
the leaves taken warm out of the infusion ; but the infusion was 
generally found far more successful. The gastric symptoms in 
this fever were not so commonly met with towards the close of 
the season ; but the distressing thirst was common to the end. 
The efficiency of the remedy was almost hourly tested until the 
close of the season, and my confidence in its uniformity of ef- 
fect thereby continually confirmed. 

One or two cases of ordinary Cholera Morbus came under 
my notice in the latter part of the season, in which it was equal- 
ly prompt in relieving the vomiting. Several sporadic cases of 
Cholera Infantum occurred after the close of the fever season, 
in which it was used with no less conspicuous benefit. Since 
the above experience, 1 have often used this infusion with the 
most marked benefit in that irritable stomach which often attends 
Cholera Infantum, as well as gastric and gastro-entcritic fevers. 

In addition to the above, I am happy in being able to state, on 
the authority and observation of my colleague, Dr. Dugas, 
Professor of Anatomy, that it has proved a convenient, prompt, 
safe and uniform remedy in Pertussis. His prescription is t<> 
give the patient one pint of a pretty strong infusion each day, 
in divided doses, until the disease disappears ; and that, in fami- 
lies having 12 or 20 cases, he very rarely has occasion to make 
another prescription — the disease generally disappearing within 
four or five days. 



150 On Amygdalus Persica — Ediract of Belladonna, [Aug. 

The power of Prassic Acid in actually curing this disease, 
immediately on arriving at the full dose for the patient, was 
abundantly demonstrated in my practice in 1822. But the dif- 
ficulties attending the use of Off. Prussic Acid are such, owing 
to the various strength, age, l&c, that it cannot ever become a 
remedy in general practice, except near a competent and cor- 
rect Chemist. 

But we here have great cause of gratitude to an ever bounti- 
ful Providence, for strewing around us a simple, safe and cheap 
remedy, accessible to all. 

I need say nothing of the efficacy of this medicine in the cure 
of those cases of Hsematuria which depend on irritations in the 
urinary passages, as it has been long known to the profession. 

Extract of Belladonna. — This article has been recently 
brought before the medical public by several northern practi- 
tioners, as a new discovery for securing an early and easy dila- 
tation of the os uteri in certain cases ; and practitioners have 
been requested to test its efficacy by experience. We also find 
since the publication of Velpeau's Midwifery, that it has been 
used for this purpose for a length of time in France. 

I notice this article on the present occasion, not for the pur- 
pose of claiming priority of discovery, or use of the article, but 
simply for the purpose of bearing testimony to its virtues. 

Some cases of rigid, iron-like hardness of the os uteri had, 
in my early practice, greatly perplexed and called loudly on me 
for some means for its relaxation. At length, about 18 years 
ago, when labouring under such a perplexity, I reflected on the 
power of Belladonna in dilating the pupil of the eye for cataract 
operations, and determined on the propriety of resorting to it 
for my present necessity. Considering it an article of much 
power, my next difficulty was to determine on the manner of its 
application. On searching for some preparation which might 
answer the demand, 1 finally adopted that of Chaussiers oint- 
ment, which I prepared and applied to the os uteri by menus 
of a vaginal syringe, truncated near the round end. I filled 
the end to the extent of about 1 inch with ointment, and after 
introducing it to contact with the os uteri, whilst, my patient 
was laying on her back, forced the ointment out of the syringe 
into the most depending part of the vagina, where the os uteri 
rested. The syringe was then withdrawn, and the ointment 



1830.] On Amygdalus Perslca — Extract of Belladonna, 1 r> i 

more particularly applied with the fingers to the whole of the 
os uteri. After two hours the opposing rigidity was found 1" In- 
yielding, and the case progressed without farther difficulty. 
Several cases have since occurred in which I have used it with 
similar success. In only one, was the second application needed. 
I have no fears in its free application in that way. after the libe- 
ral use made of it in those cases in which I have witnessed its 
safety and eificacy. 

It will not be forgotten that its use to the eye for dilating the 
pupil in cases of cataract is almost universal, and although this 
organ is one of proverbial delicacy, still we have, heard no 
complaint of its injurious effects : and I have myself often used 
it in these cases to my very great convenience, notwithstanding 
the great susceptibility of the part and the concentrated form 
in which the solution of it was applied. I would, however, from 
the fact of the unusual inflammation which attended my two 
last cataract operations, in which its application was needed for 
a long time before the pupil seemed to feel its influence, enquire 
whether other practitioners have observed, after its application, 
a degree of inflammation, out of all proportion to the good pre- 
paration and other circumstances of the case, supervene ? The 
extract used in these two cases, was procured of such as rould 
be obtained at the time for those operations, and may not have 
been of the best. Or, as both of these patients were old, and 
were black, it is possible that it was the rigidity of old age, 
which being hard to yield, required too long application of the 
article. 

For many years, I have been in the habit of recommending 
freely its use to my private pupils, and for several years past in 
my public instructions, under the name of Dilating Pomade ; not 
only for* the relaxation of the os uteri in cases of a fixed hard- 
ness thereof, but also for promoting its more pro?npt relaxation 
in those cases of labour in which general convulsions arc re- 
peated at every period for pain; also in those cases of that 
rigidity of the os uteri which retards the progress of the first 
stage of labour, and which is the most common, troublesome 
resistance in the first stage. But it has not fallen to my lot to 
have an opportunity, when it was at command, for using it in 
these convulsions ; nor have I yet been informed of its success 
or use in such cases. I think it worthy at least of trial. 



152 Cases with observations. |A- U g- 

Chaussier's ointment contains 3 i.j- extr. Belladon. to ' i. sim- 
ple ointment. Prepared Lard will be found better than the 
simple ointment, especially in winter. 

It should be remarked that none of the extracts are subject 
to greater variation of power than that of Belladonna, as we 
find it in the shops. 



ARTICLE VII. 



Cases with observations. By F. M. Robertson, M. D. of 

Augusta, Geo. 

Those who have devoted their attention, in any degree, to the 
subject of Phrenology, are aware of the function assigned to the 
cerebellum, in the arrangement of this system. The science 
not only recognises separate and distinct elementary faculties, 
but these faculties are manifested by means of separate and dis- 
tinct cerebral organs. Appeals are made, by those who advo- 
cate the science, not only to the physiological laws which gov- 
ern the progressive developement and decline of the encephalic 
mass, but also, to its anatomical structure, the pathological state 
of the organs, and the derangement in the manifestations of the 
functions dependent thereon. From these sources, a mass of 
evidence may be accumulated, which will almost set opposition 
at defiance ; for one fact is worth a volume of abstract reason- 
ing; and, while the flimsy tissue, of which the latter is compos- 
ed, is made to vanish before the superior light of truth and ob- 
servation, the former stands Unaltered in its intrinsic nature. 

Many cases, having the same bearing upon this point, as the 
two we are about to relate, may be found in the surgical obser- 
vations of Baron Larrey — some of them arc so remarkable, and 
apparently, unnatural, that they would at once appear question- 
able, was it not that the veracity of the author stands "above 
suspicion." 

Case 1st. On the Oth of October, 1834. I was called to a ne- 
gro man between thirty-five and forty years of age, who had 
fallen through a dray while the horse was in motion. In de- 
scending, the back of his head and neck struck one of the cross- 



1836.] Cases with observation^. 153 

bars of the vehicle with such force as to produce a severe con- 
lion and fracture of the fourth and fifth vertebra; of the 
':. The details of the case, so far as relates to the symptoms 
sequent upon the fracture of the vertebra) and compression 
of the spinal marrow, and the appearances on dissection, are 
recorded in another .Medical Journal.* The patient lived thirty- 
three hours alter the accident, occurred. On the day after the 
injury was received, from his having voided no urine, a disten- 
of the bladder was feared, to obviate which the introduction 
of the catheter was proposed. On examining the parts, previous 
to the introduction of the instrument, the penis was found to be 
in a state of rigid erection. The catheter was introduced, but 
no urine followed. The penis continued in a state of priapism 
until the death of the patient, and though the instrument was in- 
troduced repeatedly, not more than an onnce of urine came 
away. Upon pressure above the pubes, no marks of a distend- 
ed bladder could be observed. No twitching of the muscles, or 
the slightest convulsion occurred during the progress of the case; 
so that the priapism could not be accounted for upon the grounds 
of a spasmodic action. Doctors Cunningham, Patterson and J. 
E. Bacon visited the case with me, and the two last named gen- 
tlemen witnessed the introduction of the catheter. Independent 
of the fracture of the spine, a severe blow was received imme- 
diately over the region of the cerebellum. It is to be regretted 
that the examination, post mortem, could not have been carried 
beyond the fractured portion of the spine ; but as this was per- 
formed clandestinely, it was impossible, under the circumstances, 
t > proceed further. 

Case 2d. This case occurred during the late Seminole cam- 
paign, and was related to me by Dr. Ogleby, the Surgeon to the 
Battalion of Volunteers under Major Cooper. In the 
engagement with the Indians, in what is termed the cove of the 
Ouithlacoochee, on the morning of lie 31st March, Mr. Robin- 
lemberiofthe Louisiana A'oluntecrs, received a rifle ball 
in the back of (lie head. It entered behind the car. immediately 
over the region of the ce h, and penetrated through the 

skull, and was supposed, by his medical attendants, to have 
\\\ the substance of this portion of the encephalon. — 
His is were those usually developed by such injuries, 

I. 1st, "" ' * >( ^ . 



154 Cases with observations. L^ ll S- 

and contrary to the expectations of his friends, he lived seve- 
ral days after the wound was received, notwithstanding the 
unfavorable circumstances under which the army laboured 
relative to hospital comforts and suitable transportation for 
the sick. As the main body of the army took up the line of 
march for Tampa Bay, on the 1st of April, he was left, under the 
care of Dr. Ogleby, at Fort Cooper. In the progress of the case, 
the Doctor found it necessary, in consequence of the accumula- 
tion of urine in the bladder, to introduce the catheter ; and, to his 
surprise, when the penis was exposed, for the purpose of per- 
forming the operation, it was found to be in a state of rigid 
erection. The instrument was introduced and the urine evacua- 
ted, but the penis remained in a state of permanent erection un- 
til the death of the patient. The reaction, of course, was consi- 
derable after the reception of the injury, and it is reasonable to 
suppose that the portion of the encephalon nearest the foreign bo- 
dy must have suffered most, from the consequent inflammation. 

In this case one might suppose that the priapism was occasion- 
ed, partly, by the stimulus of the excessive quantity of urine ac- 
cumulated in the bladder ; but, this supposition is completely set 
aside by the first case, in which no urine at all was secreted for 
nearly thirty-three hours, and yet the priapism was as complete 
as in the second case ; and again, in the latter case, the evacua- 
tion of the urine produced no change whatever in this singular 
symptom. 

Those who have any curiosity to look further into this sub- 
ject, are referred to the work of Gall on the functions of the brain, 
Spurzheim's system of phrenology, and Baron Larrey's surgical 
observations. The object of this article is not to discuss the 
principles of phrenology, or to enter into an elaborate defence 
of the science, against the many unfounded and unjust imputa- 
tions which have been brought against it, but merely to give 
two cases, which certainly claim some merit as facts in proof of 
the science. Many of our readers will be inclined, no doubt, to 
underrate the bearing which these cases have upon the point in 
question, but we feel assured that strict observation cannot fail 
to render almost positive, even with the most skeptical, many of 
the positions maintained by the advocates of the doctrine ; for 
the truth of the fundamental principles of phrenology may iioav 
be considered as established upon too firm a foundation to be 



1 836.] Injury of the Head. 1 55 

overthrown by the ridicule of its opponents. The science has 
recovered from the momentary shock which was given to it by 
this once powerful engine. Facts are now looked upon as more 
important than opinions, though the latter may claim high sour- 
ces as their origin, and appeal to the consecration of antiquity. 
These are no longer a barrier to the investigator into the laws of 
nature, and fashion now possesses no terrors to him, who seek- 
ing for truth, resorts to the universal volume, in which the hand 
of Infinite Wisdom has inscribed His immutable laws. The 
science of phrenology is based upon observation, and our oppo- 
nents must resort to the same course before they can hope to ar- 
rive at their ultimate end. Ridicule we do not fear, and aa 
appeal to observation is all we ask. If the science be contrary 
to facts, let it perish ; — but, ifsup.poi ted by the truths of nature, 
its own omnipotence will vanquish every foe. 
Augusta, July 1st, 1830. 



ARTICLE VIII. 



Remarkable case of fracture and depression of the parietal bone, 
from which the patient recovered, without the operation of tre- 
panning. By B. B. Strobel, M. D., Lecturer on Anatomy 
and Surgery, Charleston, S. C. 

I was sent for in haste on the 14th day of March, 1830, at 4 
o'clock, A. M., to Mr. L * * * * *, on board of the French ship 
Isaie. He was lying on the deck in a state of extreme pros- 
tration, uttering a feeble cry. His extremities were cold, coun- 
tenance pale, lips livid, and pulse scarcely perceptible. 

The first indication under these circumstances, was of course 
to produce reaction. I ordered off the crowd which had col- 
lected, so as to admit the access of fresh air, and had the pa- 
tient's head sustained by an assistant, whilst I dashed cold water 
in his face. Reaction ensued, and the patient was conveyed 



1 56 Injury of the Head. [ A ug*. 



upon a litter to an adjacent house, and v» i *1 in an airy 

room upon a comfortable bed. 

The patient being now in a situation where I could operate 
advantageously, I proceeded to an examination of the injuries 
which he had received. I observed an extensive lacerated wound 
of the scalp, corresponding to the right parietal protuberance, 
and by the introduction of my finger into the wound, ascertain- 
ed the existence of a fracture and depression of the parietal 
bone. The fracture was about fourteen lines in length, extend- 
ing in an oblique direction from the anterior superior to the pos- 
terior inferior angle of the bone. The depression, which was 
very evident to the touch, was from six to eight lines in depth. 
My attention was next directed to an injury of the right leg, 
where I found both bones (the Tibia and Fibula) fractured. The 
extremity of the tibia projected through the lacerated integu- 
ments on the internal side of the leg, about four inches above the 
ankle joint. The patient was about thirty-five years of age, of 
good habits and sound constitution. The following statement 
was. made to me of the accident by which these injuries had been 
inflicted : 

Mr. L # * ** * was first mate of the ship, which had been 
"hove down" for the purpose of examining her keel. The ne- 
cessary repairs being completed, she was righted, and two sail- 
ors were ordered to unrcave the fall and send down the block 
from aloft. They neglected to make it fast to a rope, and threw 
it off from the main top, from whence it descended on the 1 
of the mate who was walking on deck. He was immediately 
struck to the ground, falling on his left side, and receiving the 
mass on the outside of his right leg, both bones being fractured 
by the concussion. 

That symptoms of compression would ensue, was to my mind 
almost certain, when 1 took into consideration the severity of 
the blow, and the extent of fracture and depression. I therefore 
prepared my instruments, and held myself in readiness to per- 
form the operation of the trephine. Indeed, J was disposed to 
proceed at once to the operation, as night was rapidly ap- 
proaching, and it seemed better to operate by daylight in anti- 
cipation, than to wait for symptoms of compression, with the 
chances of an operation by night. A moment's reflection, how- 
ever, and a reference to the opinions of the best authorities, de- 



183G.] Injury of Ih U a '. 157 

terminal me to defer it, until ito'genthj demanded by the necessity 
of the case* In the mean time, I adopted such precautionary 
measures as were calculated to keep down excitement, and to 
prevent determination f;> the head. The wound of the sc:dp 
was freejy laid open, and fomented with clodts wrung out in 
warm water to encourage hemorrhage, and a stimulating in- 
jection administered. The injury of the leg was m xt attended 
to — the hones were properjy adjusted, and easily kept in place 
by the ordinary splint and bandage, the fracture being trans- 
verse. 

I visited the patient several times in the course of the evening, 
and saw no material alteration, the hemorrhage from the wound 
had been considerable, the injection had operated well. The 

* We are principally indebted to Desaiilt for this improvement in modern 
Surgery. By the ancients the operation was performed in all doubtful ca- 
ses. Their practice was adopted and received without its merit being ques- 
tioned, until that justly distinguished Surgeon was induced to doubt.its pro- 
priety, from having remarked that it seldom succeeded at the Hotel Dieu 
at Paris. lie therefore declined trepanning in cases of fracture, without 
depression, or effusions of blood, and this practice, which in his hands was 
attended with great success, is generally adopted now-a-days. 

Sir Astley Cooper in his lectures commends this course. 

Larrey, in his Surgical Memoirs, page 117, makes the following remark : 
" The trephine should not be applied in wounds of the head, accompanied bv 
fracture of the bones of the cranium, whatsoever may be the extent of the 
fracture and the number of the radii, if the fragments of bone be not driven 
inward?, no foreign bodies present, or symptoms of compression not i 
evident." 

Boycr in his Traite J"s Maladies Obnrurgicale^ entertains similar opin- 
ions : 

" ?.Liis lorsqu'il n'y a ni enfoncement, ni epanchemenl de san~, on no 
tr. pane point ; on s'en tient aux moyens generaux, tels que les saignces du 
bras et du pied, les purgatifs, surtout remetique en I Lvage, qui procure des 
evacuations alvines abondantcs sans irriter bcaucoup le tube intestinal." — 
vol. v. page ?.">. 

"The instances of death, after the setting in of inflammation from very 
trilling causes, are of almost daily occurrence, and would induce us to anti- 
cipate its certainty after all violent injuries : but it is a great mistake, now 
acknowledged by the best Surgeons, to suppose thai every depression re- 
quires an elevation, and every fracture the interference of art ; although it 
is a common one fallen into by the juniors : and even among the older ciass 
I have seen operations attempted on very unnecessary occasions." — II- li- 
nen's Principles of Military Surgery. 



158 Injury of the Head. L^ug. 

fomentations were continued to encourage the oozing of blood. 
About 8 o'clock at night, however, a very evident change for 
the worse occurred. The pulse had risen, was full, hard and 
slow. The patient complained at first of a violent head-ach, which 
was soon followed by drowsiness, stupor, and difficult and ster- 
torous respiration. Notwithstanding the unfavorable state of 
the case, I resolved to make one more effort for the relief of the 
patient, before resorting to the operation. My impression was, 
that the symptoms of compression were produced rather by a 
fullness of the vessels, than by the depression of the bone. Had 
the symptoms depended upon the latter cause, they would have 
shown themselves, soon after the occurrence of the accident. 
Four hours had, however, elapsed, before they began to be mani- 
fested — it seemed, therefore, reasonable to conclude, that the 
subsequent determination of blood upon the brain, which took 
place, when full and perfect reaction ensued, was sufficient to 
account for their occurrence. The remedies which I proposed, 
if they proved beneficial must be prompt and efficient in their 
action — but little time would be lost in giving them a trial, and 
there was a possibility of avoiding a serious and dangerous 
operation. 

I tied up the arm and bled the patient until he fainted— tap- 
plied cloths wrung out in cold water to his head, placed his feet 
in a tub of hot water, rendered more stimulating by the addi- 
tion of mustard, and gave an injection composed of spirits of 
Turpentine and Molasses. 

The conjoined effect of these remedies was soon evinced. The 
difficult and stertorous breathing, stupor, drowsiness and head 
ach disappeared, and the pulse became soft and natural. I was 
not, however, satisfied with having attained this much, but de- 
termined if possible to prevent a recurrence of the unpleasant 
symptoms. Cathartics were not only likely to keep up a con- 
stant drain from the bowels, but were also calculated, by their 
irritating impression on the intestinal tube, to counteract deter- 
mination to the head on the principle of revulsion. The furred 
condition of the tongue, also seemed to indicate the propriety of 
their administration. I therefore ordered 15 grains of Calomel 
to be given immediately, and in two hours after taking it, a 
wineglass full of a saturated solution of Epsom Salt every 
hour "pro renata." 



1836.] Injury of the Head. 150 

I visited the patient at 12 o'clock. His Medicine had operated 
several times. No return of head ach — pulse natural — skin 
warm and moist — directed the solution of Salts to be continued, 
the same dose, but at intervals of two hours. 

March 15th, 5 o'clock, A. M. — The patient doing well, pulse 
natural, skin moist and warm, tongue clearing off, no uneasiness 
about the head.- The medicine had operated ten or twelve 
times, producing large watery stools, mingled with bile. Or- 
dered the Cathartic to be discontinued, and the patient to be kept 
on a diet of arrow root, rice or barley water, and cold water. 
From this hour the patient complained no more of his head, 
although he suffered much from his leg. I visited him several 
times during the day, and observing no returning symptoms 
of compression — shaved the scalp and approximated the edges 
of the wound with adhesive straps. — It healed as kindly as 
could have been expected, in part by granulation, and in part by 
the adhesive process. The patient w r as kept on a rigid system 
of low diet for twelve or fourteen days, to prevent a recurrence 
of the unfavorable symptoms. In the course of five weeks the 
wound of the scalp, had entirely healed — the depression of the 
bone remaining very evident. The fracture of the leg had so far 
united at the expiration of six weeks, that this individual was 
enabled to return home in the vessel. 

After the recovery of the patient, I had the curiosity to make 
an examination of the block. It was what sailors term, "a three 
sheave block," used at ship-yards for heaving down vessels. 
It was bound with iron hoops or straps, and weighed two hun- 
dred and fifty pounds. 

It really seems surprising, (almost incredible.) that such a mass 
should have fallen from a distance, upwards of thirty-five feet, 
on the head of a man, without instantly killing him. Cut the 
result is easily explained by a reference to mechanical princi- 
ples. Had an iron ball or any hard irregular shaped substance 
fallen from the same height upon the head of an indivi- 
dual, it is more than probable, that the fracture and depression 
which would have resulted, together with the consequent inju- 
ry of the brain, would have been attended with fatal consequen- 
ces, and the reason is obvious — the whole momentum would 
have been communicated at a given point. Here, on the con- 
trary, we have a large mass of great weight, with smooth round- 



*60 hiju L Al,,r - 

ed surfaces slrHiing obliquely — the momentum bei reat 

as instantly to throw the body from the line in which i was 
falling'. " Had th< sam< mass fallen frcm the same dists ? in 
a straight lin ead of striking 6bliquely, the •■ ce 

vvhich the body would hafce offered, would probably 
have shattered the cranium to>atams>hut would in all j tlity 

have crushed the bones of the inferior extremities, ; well as 
many of the bddy generally, f It is thus by the application of 
the principles of Physical Science, that we are enabled to ex- 
plain the nature of injuries, and not unfrequently to* deduce our 
prognosis. 

* Mr. Quesnay, in an essay od the use of the trephine in doubtful cases, 
(published in the 1st volume of the ?! >,,' ; .- s de I'Academie Royale dc Chi- 
rurgie,) slates "that a stone of twenty pounds weight tell perpendicularly 
from a heighl on the head, and occasioned no fracture, whilst a blow from 

t lie list on the temple produced a fatal eif Vision." There can be no doubt 
that the force of the blow from the stone was greater than that inflicted by 
the fist. How then can we explain the diilerent results, except by the angle 
of incidence ? — the blow from the fist being direct, or in a straight line, 
whilst the stone must have struck obliquely. I once made a post-mortem 
examination of a woman who died from a rupture of a blood vessel on the 
brain, producing effusion within the cavity of the cranium. This injury fol- 
lowed a blow on the top of the head from the fist of a man. The woman was 
an habitual drunkard, and had brought on a condition of the vessels, which 
predisposed them to rupture. It therefore became a very nice point of me- 
dical jurisprudence to determine, whether such a blow under other and 
favorable circumstances would have proved fatal. 

{ By calculation the momentum may be ascertained with some degree of 
accuracy. The following process may not prove uninteresting. 

Let the quantity of matter (M) = 250 pounds. Space through which it 
foil (S) = 30 feet. Space through which a body falls in one ,\ cond, (M) = 
16 icet. 

Then {Oh mics, An. 53.) 

T (time of falling) = y/l = yj \[~- \ seconds nearly V (velocity acquir- 
ed hi that time) 2 m x T = 2 X 1G x - A =40. This di \ for re- 
sistance of atmosphere, etc. leav< s3*2 for the velocity. 

T 1 ;" momentum would th refore be equal to M x S = 250 x '■'- 
8000, a force sufficient to crush a man's skull to pieces, had it fallen upon 
it directly. This however did not, occur m the preseni instance. Let 
us th poi e that . from the perpi i degrees, i.e. 

at an angle of * I s. This by the resolu- 

tion of forces would give for its momentum, the si ht angled 

triai'/ i - 



L330.] Injury of the Head. 161 



[Cambri tge Trig. 


Art. ■' '. 


BC - 8000 




A = 30 




n 60 




As Radius 


10,00000 


ito BC. 8090 


3,90309 


jsin. C 30 


9, ©897 



to AD -1009 3,60206 

Vri: 18 of the same.) 
Here the n a is reduced to just; one half of what it was at first. 

Four ll . however have crushed the scull to all intents 

and purposes, as effectually, as 8000, had the head been confined in its posir 
by a force equal to tjie momentum. But as the resistance offered, was 
only that of the muscles together with the inertia of matter, which in this 
case may be estimated at 100 lbs., we have the. force of infraction greatly 
Med. For action and reaction being equal — itis evident that the force 
of the stroke must have been equal to the momentum lost by the body (block) 
in the concussion. This we ascertain as follows : (Sec Cavallo part 1, 
art. 2.3, 24.) 

A (Block) == 250 
B (Head) = 100 
V (velocity required to make the momentum of 250) = 4000 

A B V 250 x 100 x 16 = 400000 

= = _. 1143 lbs. 

A -f B 250 + 100 == 350 

Momentum lost, or force of percussion, supposing the block to have struck 
with its center, but as it probably did not strike with its centre — the force of 
the blow would again be modified by this circumstance, and probably not 
exceed a force of 5 or GOO pounds. This proposition may be rendered more 
intelligible by supposing an iron or other metallic weight of 1000 lbs. to fall di- 
rectly from a moderate height, upon a leaden ball resting on an iron floor — 
the effect would be to flatten the ball. If however both were freely suspended 
and the weight made to impinge against the ball from a distance equal to 
the height from which it had fallen directly upon it, the effect would be no1 
to flatten, but to send it off with oreat velocity. 



1G2 Grey Sulphur tyring*. [Ar-u- 



Part II.— REVIEWS AND EXTRACTS. 

Account of the Mcdiccit I Properties of the Grey Sulphur Springs, 
Virginia. Charles ton, printed by A-. ii. Miller, lbS&v. 
p. p. 18. 

It is not every bearing of our professional duties which is cal- 
eulated to add directly, and some of them not eyen remotely to* 
the dollars and. cents of our annual income. Indeed, some ot> 
the most dignified and honorable duties — those to which the 
profession is largely indebted, for the respectable rank it enjoys-; 
amongst the liberal and exalted callings* instead of ever tending, 
to pecuniary gain, have only for their reward the happy con- 
sciousness of having discharged duties to humanity at our own 
expense — of having done good to our friend* our neighbour > 
not only by being accessary to his welfare, but also in effecting 
this good at the least possible expense to him. Such arc the 
duties of searching out and effecting the correction of local cau- 
ses- of disease — instructing the community on- the subject of in- 
jurious customs, habits or fashions ; as imprudence in dress, in- 
dulgence in the enervating, health-destroying luxuries of life r 

&LC. &LC. 

These duties when faithfully performed', tend most certainly 
to lessen, to a greater or less extent, the sum' of physical evil* 
to which humanity is subject ; and thereby diminish the calls oru 
the practitioner.. Their faithful and abundant performance i» 
properly considered as an indication of the in-dwelling of that 
humanity and benevolence which are the diamonds and rubies- 
among the jewels in the professional casket. If aught in man- 
can be disinterested, such must be these noble deeds. And 
here we would not withhold a tribute of respect due to the 
medical men of the world, and particularly of the United States ; 
not individually, but as a community, for the noble stand they 
have taken in the temperance reformation. 

Regardless of the effects of the wrath of those whose income 
from the grossly immoral — manslaughtcring custom of traffick- 
ing in intoxicating liquors would be lessened by their successful 
influence on the community, they have exercised a noble deci- 
sion, and independence of character, most honorable to any fra- 
ternity or class of men. They have, in many instances, know- 
ing that their daily bread must come from the popular favour 
around them : and, regardless of self-interest in the virtuous 
hope of arresting the fatal progress of a mighty and devastating 
torrent, filled with the worst of physical and moral enemies to 
humanity, dared to bring forward the armamentary of their 
conclusive testimonials and pathological science, and occupy 
with unwavering firmness the posts i f greatest danger. 



V836.] Grey Sulphurr Sjorings. MB 

Nor have fbey been merely passive watchmen on the ram- 
frizes of health and morality, but have led. the croisnde against 
.a ruinous and mighty enemy to both, which was cherished, like 
the frozen viper by I he husbandman, in the houses of their best 
friends — sanctioned, like all vice familiarized by universal ap- 
probation ; and made strong and resisting, like the chains of 
superstition, by the habit of centuries. 

We have been led to these reflections by reading tlrc little 
pamphlet described at the head of this article, and searching for 
the reason for the infroquency of the prescription of mineral 
waters by physicians. As medicinal means afforded by a kind 
Providence for the relief of human afflictions, mineral waters 
-should be regarded as amongst the most important. Nor are 
•there any good reasons why they should not be used in medical 
(prescriptions with as much promptness as any other articles of 
tthe materia medica. 

We may say, and with truth too, that these are articles with 
which, from their distance, and want of observation of their opera- 
tion, we have not become so familiarly acquainted, as with the 
articles of commerce which are found with the apothecary. 
But this should not be so. These natural productions are not 
less worthy of our attention than other mineral, vegetable and 
•animal productions, which make up the sum of our .ressmedieoa. 
For when the whole assemblage of all things an&erreum stances 
(brought into operation by a travel to some watering place, is 
better calculated to imeet the necessities of our patients, than our 
•protracted and too often unsuccessful attempts to imitate by 
•art what nature has better prepared, it becomes our imperious 
•duty to prescribe them. Nor w'ffl that ignorance of them 
which may prevent our knowing their superior powers, fully 
»excuse us ; for it is not only the duty of the practitioner to do 
for his patient the best he knows, (a common, but not a very 
.flattering recommendation by the way,) but it is to do the best 
that can be done. 

The infrequency of these prescriptions cannot be -attributable 
to the desire of retaining the business of the patient in hand. 
■Such a charge cannot hold at the present day amongst those 
who merit a place in a profession in which the purpose of ma- 
king a fortune, or even a competence, must be secondary to that 
of doing good to suffering humanity. And such is the profes- 
sion of medicine ; and he who cannot subscribe to, and act upon 
this principle, should be as promptly proscribed as one who 
would traffic or indulge in the use of intoxicating drinks. 

In the pamphlet we are presented at once with two most im- 
portant medicinal powers ; the productions of no Swaim nor Mo 
rison imposition or secrecy ; but of the pure and perfect labora- 
tory of nature, accompanied with a qualitative analysis of their 
'elements, and satisfactory attestations of their operations as 
anedicinal powers. 



164 Grey Sulphur Springs. [-^ ll 3 



For the benefit of the profession, and through them, of the 
community at large, we give a few selections from the pat 
of the pamphlet itself: for we think these, as well as m >sl 
other medicinal means, suffer great loss of good effect, and con- 
sequently, loss of character — to say nothing of the injuries they 
effect, in consequence of a promiscuous and unscientific adop- 
tion of their use. And we would here say in passing, to such 
(if such there be) as would dislike too much the loss of their 
daily attendance, to recommend their patients to a course 
which would compel their absence ; that it were better to make 
the prescription, and satisfy their thirsty avarice by a bold de- 
mand at once on the pockets of their employers for the prescrip- 
tion, than not to make it at all. 

On the first page, the location of the Springs is thus de- 
scribed : 

"The Grey Sulphur Springs are situated near the line, dividing the coun- 
ties of Giles and Monroe, Virginia , on the njain road leading from the 
Court-House of the one to that of the other. They are three quarters of a 
mile from Peterstown, nine miles from the Red Sulphur, and by the County 
road, twenty and a quarter miles from the Salt Sulphur Spring. In travel- 
ling- to the Virginia Springs, by either the main Tennessee or Goodspur 
Gap Roads, and crossing the country from Newborn, by the stage road to 
the Sulphur Springs, the Grey Sulphur are the first arrived at. They are 
thirty miles distant from Newborn. The location is such as will admit of 
many and varied improvements, which when completed, will render this 
spot an elegant and desirable resort during the summer months, indepen- 
dent of the high medicinal properties of the mineral waters." 

On the same and following pages, we have a description of 
the Springs : 

"There are two Springs at this establishment, situated within five feet of 
each other, and inclosed in one building. Although rising so near to i 
otiier, yet they differ most materially in their action on the system. Both 
appear to be peculiarly serviceable in dyspeptic cases, and in such as origi- 
nate in a disordered state of the stomach — the one, in those in which inflam- 
mation exists, the other in such as proceed from torpidity. They have 
hitherto been known as the large and small Springs ; but having succeeded 
towards the close of the last season in procuring a much larger supply of 
r at the small Spring than is afforded at the large, a change of names 
ime necessary. The large will hereafter he known as the Anti-dyspep- 
tic, and the small as the Aperient, winch names wdl serve to point out their 
peculiar characteristics. 

"Thei e Springs have been classed by Professor Shephard, as « AVcalino 
■ i\- so i- •'•■ ly met with, that another is not known to 
elsewhere in th( United States. The waters are beautifully clear; 
ai i liighly charg< 1 v ith gas, which render them light and extremely plea„- 
sant, thei iti-dyspeptic Spring, which produces none oi 

tho- • unpleasant sensations so frequently felt on the first drinking of mine- 
ral v 

«\V; . me f the water was submitted to a. chemist for 

analysis ..the qua;" ' DO small for him to ascertain all its 

I has been made by Professor C. IJ. 
Shcnhard, who has famished us with the following abstract of an articlq 



1836.] Grey Sulphur Springs. 103 

which appears in the April Number (1836) of Professor Silliman's Journal 
of Science and Arts." 

"The following is the most satisfactory view which my experiments ena- 
ble me to present of the condition of these water.- : 
Specific gravity, 1,003. 

SOLUBLE IXGREDir.VTS. 

Nitrogen, 

Hydro Sulphuric acid, 

Bi-Carbonate of Soda,* 

A Super Carbonate of Lime, 

Chloride of Calcium, 

Chloride of Sodium, 

Sulpliate of Soda, 

An Alkaline or earthly Crcnafe, or both. 

Silicic acid. 

INSOLUBLE INGREDIENTS. ' , 

Sulphuret of Iron, 

Crenate of Per Oxide of Iron, 

Silicic acid, 

Alumina, 

Silicate of Iron. 

My experiments do not permit me to point out the differences between 
the two Springs with precision. The new Spring appears to give rise to a 
greater amount of hydro-sulphuric acid, as well as of iron and silicic acid. 
Probably it may differ in still other respects. I have not examined it for 
Iodine or Bromine. 

As no regular analysis was attempted, the quantities in which these seve- 
ral ingredients exist, still remain undetermined. That they are in different 
proportions in the two Springs, is evident rot only from their depositee, but 
also from their action on the system. The action of th° anti-dyspeptic 
Spring is diuretic and gently aperient, tending to restore the healthy per- 
formance of the functions, and reduce or diffuse the local irritations or" dis- 
ease. The Aperient Spring w T hile it possesses all the alkaline properties 
of the other, has an aperient and alterative action. Possessing more iron, 
(of which the other has but a trace,) it acts more powerfully as a tonic, 
whilst its other ingredients cause it to act in some cases as a very powerful 
aperient. 

As these Springs have been visited by invalids, only during the two last 
seasons,— it is reasonable to suppose that all their properties have not yet 
been discovered, nor all the cases ascertained in which they can be bone 
finally used. In fact, owing to the small quantity of water furnished hither- 
to by the Aperient Spring, its qualities have been but little tested, and there 
can be no doubt, (judging from its constituents) that it will be found equ 
salubrious as the anti-dyspeptic Spring, only better adapted to another 
class of cases. To give a general idea of the properties of these waters, 
we might say that they are peculiarly serviceable in those diseases which 
originate in a disordered state of the stomach and bowels, and also in he- 
patic affections. It is proper, however, to enter more into details, and we 
therefore submit the following synopsis of the medical properties of the 
etntUdyspeptic Spring. 

Medical Properties. 

1. It relieves nausea and headachs, arising from disordered stomachs. 

2. Neutralizes acidity, and if taken at meals, or immediately after. 



* It cannot be determined whether free carbonic acid exists in tin ■ 
tors without going into a quantitative analysis. — C. U. S. 



1GG Roslan on Diagnosis* I Aug. 

a tendency to prevent those unpleasant sensations so often experienced by 
invalid?, from indiscretion in dieting*. 

Jl> Is an excellent tonics exciting- appetite and imparting strength to di- 
gestion. 

4. Quiets irritation of the alimentary canal. 

5. Controls and lessens the force of the circulation when unnaturally 
excited by disease, and often in this way, is remedial in internal inflamma- 
tion of the organs. 

6. It tranquilizes nervous irritability. 

7. Is a mild and certain expectorant, often allaying dyspnoea, and pro- 
moting recovery from chronic ailments of the chest or wind pipe. 

8. It alters the action of the liver where this has been previously de- 
ranged, in a manner peculiar to itself, and under circumstances in which 
the ordinary alteratives are forbidden by reason of their exciting, or other- 
wise irrelevant properties. 

9. It is also sudorific or diaphoretic ; and 

10. When taken at bed-time, often proves itself soporific : apparently 
stilling that indescribable, but too well understood inquietude, which so fre- 
quently and unhappily interrupts or prevents the repose of the invalid, and 
especially of the dyspeptic." 

Next follow seventeen minutely and well detailed cases which 
have been subjected to the powers of these waters, which tend 
most satisfactorily to sustain the above account of their medici- 
nal virtues : to which we may add, by looking over these cases, 
a peculiar and valuable power of so allaying vascular irritation, 
as to reduce with great promptness the morbid frequency of the 
pulse, &c. 

In addition to the testimonials of the medicinal powers the 
pamphlet contains, — the originals of which, with their proper 
signatures, are in the possession of John D. Legare, of Charles- 
ton, we have found in several instances corresponding evidence 
in the accounts given by invalids who visited these Springs in 
1835, and- with whom we have conversed. 

The pamphlet concludes with the decided and favorable judg- 
ment of Professors Moultrie and Dickson, of Charleston, from 
the testimonials submitted to them : and the time has gone by 
when such men as Moultrie and Dickson may be expected to 
give their names to an expression of approbation which is not 
fairly deduced from sound premises. 



Rostan on Diagnosis. 

We know of no better appropriation of a few of the pages 
of this journal, than to the insertion of the following extract from 
a work rarely found in the hands of the American practitioner ; 



1836.] Rostan on Diagnos s. 1(>7 

to whom it is of too much practical importance in every day's 
business, to await the circulation and reading of an entire trans- 
lation of the whole work, should it be ever offered to the Ame- 
rican public. 

We feel assured that a diligent attention to it cannot fail to 
add greatly to the facility and clearness of Diagnosis, and con- 
sequently to the correctness and value of therapeutic efforts. 

On the mode of interrogating and examining a patient, and of recording cases. 
Translated from Rostan's Work on Diagnosis. 

Nothing is more embarrassing to the physician commencing the practice 
of his profession, than the act of interrogating and examining a patient. 
Indeed, this part of the art, of undoubted importance, since without it we 
can arrive neither at a sure diagnosis nor a rational treatment, is so ne- 
glected, that few practitioners, even among those of great experience, 
acquit themselves in a creditable manner. We frequently remark the in- 
coherence and disorder of their questions, their uncertainty and hesitation ; 
losing sight of certain fixed principles, we see them passing without motive, 
from one object to another, between which there is no connection. They 
repeat unnecessarily the same questions, and those immaterial ; they forget 
the most important points ; they confound subjects the most dissimilar, and 
separate those having the greatest similarity ; and to crown the evil, they 
are involved in obscurity, and by the merest accident, arrive at a just diag- 
nosis and at a rational plan of treatment. All these disadvantages are the 
result of a defective order — of a want of method. 

On first approaching a patient, we almost involuntarily examine Ins exte- 
rior : his physiognomy first attracts our attention ; at first sight, we form 
an idea of his age, his strength, his mcro-1 state, &c, circumstances of 
great importance, connected as they are with the prognosis and the thera- 
peutic indications. This first examination should not be confined to the head, 
but extended to the whole surface of the body ; but unfortunately, this can 
be done only in a very few cases, particularly in private practice. At least, 
we must not dispense with the examination of the part affected ; if neglect- 
ed, it is at the hazard of committing the gravest errors of diagnosis and treat- 
ment. Some examples will illustrate the utility of this investigation. An 
aged female, of limited intelligence, was brought to the infirmary, &c. She 
complained of a violent pain in the abdomen, about the left iliac region. 
The face was animated, the skin hot and moist ; the pulse strong and fre- 
quent, tongue dry, thirst urgent ; otherwise the digestive functions in a na- 
tural state : little or no change in the other organic or animal functions. 
The abdominal pain was increased by pressure and by motion. Behold our 
diagnosis ! The phenomena of reaction [the strong pulse, flushed face, 
thirst, &c] indicate an acute state of disease, doubtless inflammatory; the 
local symptoms point out the abdomen as its seat, but the digestive functions 
being in a normal state, it cannot be in the organs of this function ; as the 
slightest pressure is painful, the disease must be superficial ; and as the 
slightest motion is painful, then the organs of motion must be affected. 
Tlie muscles of the abdominal parietes must be diseased ; although rheumatism, 
especially in old subjects, is not usually attended with such marked symp- 
toms of general reaction. Satisfied with this reasoning we left the patient, 
after prescribing a weak infusion of cumfrey, an enema, diet and rest ; when 
a student, having exposed the part to view, discovered the existence of 
zona ! This lesson impressed us more forcibly than ever with the necessity 
of using mr senses, as tlie only means of positive knowledge. 

A patient after a fall, experienced pain in the left side of the chest ; there 
was also cough, and bloody expectoration, with symptoms of general reac- 



IoS Rostan on Diagnosis, [A.ug. 

tioa. One of the most experienced and attentive pupils was charged with 
tha examination of the case, lie arrived at the conclusion that the diss ase 
was - umonia, — inasmuch as the cough and bloody expectoration in- 

dicated the lungs as the seat of the affection; and although the pain, very 
\ dent on pressure and on the motions of the chest, might possibly be seated 
ia the pariet^s of the chest, yet the general symptoms indicated a more 
profound affection of the lung itself; — moreover, by the stethoscope the 
orepitous rale was discoverable. Behold.' titers was afractur of it ribs. 
uredly, an attentive examination of the diseased region would hav< se- 
cured him from falling into so grievous an error. 

The examination then of the exterior of the 'body, and especially of the 
regions diseased, is of the utmost importance. 

We should propose it to ourselves as the definite object of this examina- 
tion of a patient, to obtain a knowledge of the'" disease and of the curative 
judications, as promptly and certainly as 'possible. There are those physi- 
cians who -continue this examination for a length of time. In some rare 
cases this method maybe preferable. People generally love to receive our 
attention to their cases — they love to entertain their physician with the 
least circumstances of their constitution, their antecedent dii , then* 

manner of living, &c. The physician in listening to- these superfluous de- 
tails, and even in encouraging them, secures the confidence of his patient, 
and inspires him with the hope of relief at liis hands, and thus produces a 
cerebral disposition favorable to the resolution of the disease; — for the 
brain, holding all the organs of 'the economy in dependence upon it, we 
perceive that its state, whether good or bad, will exercise upon them an in- 
fluence salutary or hurtful. But, how many circumstances there art. un- 
der which this protracted method would produce unhappy results r In all 
the diseases of the respiratory organs — for example, haemoptysis, peri-pn* u- 
monia, pleurisy, catarrh, phthisis, is it not very dangerous to encourage the 
patient to speak for a length of time ? If a suffering organ is thus exercised, 
shall not the disease be increased? Will not the spitting of blood be more 
abundant, or if checked, will it not thus be renewed? Will not the inflam- 
mation of the various tissues be thus increased in intensity? In such ca- 
ses, the man whose office js to soothe and quiet pain, and heal the sick, may 
thus by this method, become himself the cause of increased suffering, id 
even of death. These same remarks are strictly applicable to the diseases 
of the brain ; — indeed, in these last cases, by multiplying your questions, you 
act directly upon the diseased organ. It is then, in the great majority of 
cases, of the utmost importance, to trouble the patient with as few ques- 
tions as possible, and to accomplish, our object promptly. 

The first question that we should address to a patient is this : Where is 
your pain ! This question, which at first sight seems so simple, long ex] ■ , - 
rience and reflection commend as the best. Patients are remarkably 
prone to give their opinions about their diseases ; one will tell you he has a 
nervous affection, another that the bile torments him; this one that, his 
blood is diseased, and the other that the humours are disordered; and fe- 
males are ready to refer to milk diffused and misplaced as the cause of their 
diseases. We will not fail to receive souk- such answer, if instead *of the 
question above, we ask — How arc you ? Now, if the patient answers, I 
have a nervous affection, &C., we have gained nothing, — but in reply to the 
other question, he will very generally indicate both the function and the or- 
gan diseased, which is an important step towards the knowledge of the dis- 
fsotwiihs-tanding the precision of this question, if is. frequently im- 
possible to check this disposition to speculate upon their diseases. Some- 
times they will mistake one organ for another, complaining of pain in hte 
stomach; when the chesl is ' cted, &c. — il istlien f< re-important, in order 
ti tvoid all possibility of mistake, to insist on the hand being applied over the 
painful region. 



lvS.'U).] Rosffin on Diagnosis. 109 

There is one other question not less important than this first one, which 
will much abridge the labour of investigating the case. This question is 
eminently analytical — How long hare you been sick? If the disease be re- 
cent, we then at ouce exclude from our attention all the chronic diseases to 
which the organ now affected is liable — if it has existed for a long time, 
we then concentrate our attention upon its chronic affections. This ques- 
tion then is scarcely less useful than the first. 

After discovering what function is injured, we should pursue the examina- 
tion, until we shall have passed in review, all the morbid phenomena which 
it is capable of presenting. This object accomplished, we should then fix 
our attention upon the organs most closely connected with the one diseased, 
and examine their state with equal care : indeed, we, should then proceed 
to examine all the organs and all their functions, without any exception. 
This precept should never be neglected, for by this examination, thus care- 
fully made in the commencement, we acquire an exact knowledge of the 
sympathetic phenomena. When an organ is profoundly altered, it reacts 
upon others, disturbing their action and altering their organization ; how 
shall we be able in the progress of the disease, to recognise such alterations 
as consecutive, if we have failed to acquaint ourselves with the state of 
these organs at its commencement ? 

Again, by this general examination, we inform ourselves of the existence 
of concomitant diseases ; for it frequently happens that many diseases exist 
simultaneously in the same individual. The patient then points out the 
most prominent of these diseases, and if the physician be satisfied with the 
diagnosis of this one disease, he will overlook the others, and may subject 
his patient to a fatal treatment. 

This, unfortunately, is not an unfrequent occurrence. Satisfied with dis- 
covering the existence of one disease, we are disposed to forget that others 
may exist. We cannot, then, insist too much upon this precept, that we 
examine with the most scrupulous care all the organs of the animal economy 
and the state of all their functions, at the commencement of every disease. 

After examining the patient in this manner, we should acquaint ourselves 
with the state of the organs in the various cavities ; — for this purpose we 
resort to percussion and auscultation for the chest, percussion and feeling, 
for the abdomen, &c. 

Percussion of the thorax is executed in the following manner : the patient 
should be seated, and present most prominently the parts of the thorax to 
be examined — if we examine the back, the head sltould be bowed, the spine 
curved, the arms folded on the breast ; — in this attitude, the back is most 
fully developed, and its muscular covering as thin as possible. If we would 
examine the side, the arms should be alternately raised upon the head, and 
the body inclined successively to the side opposite the one we are exploring. 
For the anterior part, the recumbent position is preferable, with the arms 
separated from the trunk. It is almost needless to add, that there should 
be as little clothing as possible. 

The physician, having united his fingers in the form of a cone, strikes 
successively the different regions of the thorax, taking care to compare the 
corresponding parts of the two sides only, and to strike these always at tli£ 
same angle — not comparing the sound which percussion renders, when 
made upon the intercostal spaces, with that which it renders when made 
upon the ribs—and proportioning the force to the thickness of the thoracic 
parietes, and especially to the degree of sensibility of the patient ; for there 
are cases, in which the degree of pain forbids this mode of exploration. 

On examining the chest of a sound man, by percussion, we obtain a sound 
which we may compare to that of a tambour covered with a thick cloth. 
This resonance is most remarkable at the anterior, superior and lateral part 
of the thorax ;— it is less in the back, upon the shoulder-blades, in the re- 
gions of the heart and liver. In some thoracic affections, this reverbera- 
tion, which depends upon the presence of air in the pulmonary cells, ceases, 
22 



HO Iioslan on Diagnosis. [Aug 

_— • 

and in others it augments. In the first case, we obtain a dull sound, on- 
percussion, which has been compared to that produced by percussion of the 
thigh ; we may then conclude, either 1st, that the air no longer penetrates 
into the pulmonary tissue ; or 2d, that either a tumour or a fluid is inter- 
posed between the lung and the side of the chest. If, on change of position, 
the dull sound also changes its location, and occupies t! e- most depending 
position, while the clear sound is heard in the most elevated part, we may 
infer that the cause of dulness is a liquid body. 

Percussion is one of our most certain and profitable means of examina- 
tion. It seldom deceives those who practice it with skill. But it is neces- 
sary to pronounce cautiously upon slight differences ; that this sign may be 
valuable, it is neeessary that the ear be able to distinguish the difference of! 
sounds from the two sides of the chest, that exists in numerous cases. 

As to the increase of this resonance, it depends upon the fact that the? 
thoracic cavity contains more air than natural. As we shah have occasion 
to recur to this subject, we will confine ourselves to the remark, that this phe- 
nomenon may lead us into a singular mistake — it may induce us to believe 
that the side which resounds most perfectly is the sound side, and the other- 
side is diseased, — which is the reverse of the truth. 

But if percussion be thus useful, it is not without its inconveniences. lit 
the first place, it compels us to throw the patient into fatiguing positions, and" 
the efforts he thus makes, may exasperate the disease.. In the second place r . 
the acute diseases of the chest in which we chiefly resort to this mode, hap- 
pening generally in the winter season, it is to be feared, that the impression- 
of the air upon the chest nearly naked, may coincide with the original cause 
and augment the disease. Finally, we should dread dangers from the act 
itself, since it is impossible to strike thus in the region of pain, without ex- 
tending a hurtful shock to the suffering part itself. These inconveniences 
are such as almost to balance the advantages of this plan; at least, we- 
should resort to it only when the diagnosis is obscure, and when i L , may fur- 
nish some important indication ; when the diagnosis is sufficiently clear, we 
should abstain from it. 

Recently, M. Piorry has contrived to effect percussion, by applying upon 
the region to be examined, a thin plate of wood,, of metal, or of ivory ; by this 
means he avoids the inconveniences of immediate percussion, and obtains^ 
more exact and precise results. 

This mediate percussion is less painful than the direct ; the shock and 
commotion of the organs are scarcely perceptible ; we may practice it over 
the clothing and upon soft parts ; serous infiltration of the sides of the abdo- 
men or thorax, excessive fat, even a blistered surface will not hinder this 
mediate percussion. It is more easily practised, and the mode of applica- 
tion being constantly the same over all the regions, there will result no dif- 
ference of sound occasioned by the process itself which we cmplo)', so that 
we can determine exactly the regions corresponding with certain organs, 
measure their dimensions, estimate their consistence, &c. It is in abdomi- 
nal percussion that these advantages are most conspicuous. 

By means of this instrument, M. Piorry recognizes numerous varieties of 
sounds, which he has endeavored to express by the terms femoral, jecoral,. 
cardial, pulmonary, intestinal, stomachical, osteal, humoral, hydafic, <Jc We 
shall not follow him in his definitions, nor in the divisions of the trunk rela- 
tive to the sound of the organs, in the sound state ; these differences of 
sound may be easily conceived of. By consulting his work,* we will per- 
ceive the advantages which he proposes to attain, by this mode of exami- 
nation. Admiring the zeal of M. Piorry, and felicitating him upon his ef- 
forts at establishing with precision, the diagnosis of diseases, he yet seems 



* De la percussion mediate et des signes obtenus a l'aide dc ce nouveau 
moyen d'exploration, &c. — in the College Library. 



i$3(3.] Roslan on Diagnosis. 171 

to us to attach too much importance to this mode of examination, and to deal 
Touch in conjecture ; nevertheless, we could but approve this means, even if 
it possesses only some of the advantages attributed to it, by this author. 
Every thing- that sheds light on — whatever affords any aid in appreciating 
the different states of the viscera, should be eagerly welcomed. 

Mediate auscultation gives us the knowledge of a great many phenome- 
na, useful for diagnosis; — this mode of research is so generally practised 
now, that we need not describe the stethoscope, the instrument with which 
it is performed. We apply exactly, one of the extremities <ef this instru- 
ment upon the points of the thorax to he examinee!, and the ear to the other. 
If we would examine the anterior of the chest, the patient should be on his 
iback, and on the left side when we examine the right, &c. The patient 
should sit up and lean forward when we examine the back. 

By auscultation, we explore the voice, the respiration, the rale and the 
circulation. 

The stethoscope has been employed also, for appreciating more exactly 
the crepitation, when obscure, produced by rubbing of the broken fragments 
in fractures ; and, also, for detecting the sounds^which the foetal circulation 
produces, which furnish an invaluable sign of the state of pregnancy. 

Having spoken of the mode of practising auscultation and percussion, we 
■must dwell a moment upon that of exploring the state of the arterial circu- 
lation—of the feeling of the pulse. 

The arrival of the physician generally produces some emotion, either of 
■fear or hope, &c, which disturbs or accellerates the circulation. We should 
therefore wait until he regains a state of calmness. 

In whatever situation arteries of a sufficient size are superficial, we may 
feel the pulse. It is sometimes of importance to compare the pulsations of 
the arteries in different parts of the body. We may feel the pulse at the 
temporal, carotid, axillary, brachial, radial arteries, &c; it is at the 
last that the examination is generally made. The crural arteries and 
those of the foot may also be used. 

Having assured ourselves that there is no obstacle to the free circulation 
of the blood, the patient lying on the back, we place the fore-arm in a state 
of pronation, we apply the extremity of four fingers over the course of the 
artery, so that the ring-finger shall be towards the elbow, and the index- 
finger towards the hand of the patient, i. e. feeling the puke ©f the Tight 
side with the left hand, and vice versa. If the patient be up, we cause him 
to be seated, and place his arm in the position above described. The fingers 
of the observer being thus disposed, the hand is steadied by resting the 
palm, or simply the thumb upon the posterior surface of the fore-arm ; we 
thus conveniently exercise different degrees of pressure for determining 
the degrees of resistance cf the pulse. 

The exploration of the abdomen by feeling and pressure, merits special 
attention, and furnishes important information. The patient should be 
placed in the recumbent position, with'the head bowed upon the chest, by 
means of pillows, the thighs and legs flexed upon the pelvis and thighs, the 
knees separated, the arms extended at the sides of the trunk — a position, 
which relaxes most perfectly the muscles of the abdominal parietes, and 
thus favors the examination of the viscera within. 

In thus examining the abdomen, we should remember that we divide it 
arbitrarily into many regions, to each one of which different organs corres- 
pond. The knowledge of this branch of anatomy of relations, is indispen- 
sably necessary to diagnosis ; for if we encounter in one of these regions, 
phenomena, unobservable in health, we may, with probability, attribute 
these to the organs corresponding with this region ; the probability amounts 
to certainty, if the function of one of these organs is altered in a corres- 
ponding manner. Thus we know that the stomach occupies the epigastric 
region, extending partially into the two hypocondriac regions ; if we find a 
tumour hi this region, there is a strong probability, that the stomach is the 



172 Iiostan on Diagnosis. (Aug 

seat of this tumour, but if the functions of this organ are disturbed, we are 
certain of its location. 

We should remember, however, that extraordinary instances of displace- 
ment of the viscera sometimes occur ; we once, for example, found the py- 
loric extremity of the stomach in the left iliac fossa. Having placed the 
patient in a proper position, we apply the hands carefully at first, but after- 
wards more freely over every part of the abdomen. We thus inform our- 
selves of the degree of sensibility of these parts, of their suppleness, their 
tension, their volume and the tumours they may present. All these symp- 
toms are of the utmost importance in the diagnosis ; but the tumours of 
the parts throw the greatest degree of light upon it. We should examine 
with care, the seat, the form, the volume, the consistence, the sensibility 
of these tumours ; we should remark whether they are moveable or adht- 
herent, temporary or permanent, pulsative or not ; — for each of these pro- 
perties announces different alterations. The seat indicates the organ, the 
consistence informs us of its contents, whether gas, liquid or solid ; the pain 
indicates the nature of the tumour and the kind of change nature is effect- 
ing in it ; — its mobility encourages the hope that it is formed of matters 
contained in the intestines ; in a word, if temporary and changing, it is either 
a hernia or formed of matters capable of disappearing ; if pulsative, it h 
connected with the organs of the circulation. 

When the belly is considerably distended, and we suspect it to be either 
by liquid or gas, we operate percussion in a peculiar manner. In the first 
case, with one hand we strike against one of the sides, the other hand be- 
ing placed on the opposite side ; — we then feel a kind of liquid column 
striking against the opposite side— this phenomena is called fluctuation. 
If the distension be occasioned by gas, on fillipping the abdomen, we obtain 
a clear sound like that of a drum. 

This abdominal pressure has been applied even to the investigation of dis- 
eases of the chest. 

Bichat suggested, that since distension of the stomach augmented the 
difficulty of respiration in aneurism, in hydrothorax and hydropericardia, 
&c, the elevation of the diaphragm by rapid pressure upon the abdominal 
parietes, from below upward should afford some information important in 
the diagnosis of thoracic diseases. He observed that, in pneumonia, this 
pressure produced involuntary cough and a sense of suffocation; that in 
pleurisy on the contrary, none of these phenomena were produced. In 
effusion within the chest, he observed the same kind of difficult respiration, 
the same suffocation, the same cough. 

In hydropericardia, a disease so difficult to recognize, he asserts that this 
pressure determines suffocation, sudden palpitations, irregularity of the 
pulse, and sometimes dangerous syncope ; that in aneurism of the heart, 
all the distressing symptoms are aggravated. At the present day, our 
means of exploration being so singularly perfected, this one indicated by 
Bichat is generally abandoned ; we should still have recourse to it under 
some circumstances. 

When the local symptoms occupy the mouth and the pharynx, we place 
the patient before a window, or direct a strong artificial Tight into the throat, 
and there are cases where we should introduce the finger into this part, 
either to search for foreign bodies, or to examine the orifice of the larynx, 
which in some affections is tumefied. 

In examinations of the uterus, and even of the rectum, we employ the 
speculum, which is made of various forms — those which gradually dilate are 
preferable, as they are easily introduced, and without pain. 

There are some circumstances which render tin's examination of the pa- 
tient difficult. In infancy, for example, it is frequently very difficult to arrive 
at a knowledge of existing disease. The organs of relation being as yet 
undeveloped, we are deprived of much information, which at other stages 
of life the patient himself may give us. Moreover, the sensibility being 



)83().] Rostan on Diagnosit. 173 

excessive at this period, the sympathetic phenomena of disease are very 
prominent, and are frequently confounded in an inextricable manner with 
the idiopathic symptoms. In the decline of lite, opposite causes produce 
alike obscurity. The wearing out of the brain .having singularly altered 
those properties thai have beeu called vital, an organ may be altered, even 
extensively, and the patient have no consciousness of it. This insensibility 
prevents his complaints, and at death wo frequently find the most extensive 
disorders, without ever having suspected their existence during life: — it is 
the age of latent diseases. This defective sensibility is the reason why the 
sympathetic actions are so few and obscure, so that these general symptoms 
of reaction, which m other periods of life lead us to the knowledge of the 
disease winch produces them, or which at least indicate that the patient is 
diseased, in old age do not furnish aid towards a diagnosis. We are con- 
fined in such cases to slight alterations in the functions. 

This difficulty of examining the patient is still further increased, if he has 
not the use of his intellectual faculties. Complete deafness also is a great 
obstacle ; and if blindness be added, we can rarely obtain any information 
from the patient ; difference of language is a further obstacle to this inter- 
rogation, &c. 

There are still other obstacles which render diagnosis difficult. When 
an organ is very deep-seated ; and especially if its functions are but little 
understood, we can with difficulty understand its diseases. If the same re- 
gion enclose many organs; if the sympathetic phenomena are very numer- 
rous ; if the disease be latent ; if there are many concurrent diseases — all 
these circumstances are opposed to certain diagnosis. 

Many circumstances may induce an individual to feign disease; as the 
wish to attract pity and secure alms, — to avoid some of the duties 
which society imposes upon him — to avoid the penalties of his crimes, — 
to prolong his residence in hospital, &c. &c. Diseases may thus be 
feigned in two ways — either by representing symptoms, which really do not 
exist, or by exciting a disease, which previously did not exist: in the last 
case, the fraud is most difficult to b8 detected. The sagacious physician 
possesses many resources for discovering such imposture: after being assured 
of the possibility of simulating the disease, which he observes, and of the 
facility with which it can be done, he will enquire if there be sufficiently 
strong inducements on the part of the patient, to prompt him to such im- 
posture. He will not neglect to note the degree of intelligence of his pa- 
tient. He will examine if the age, the sex, the exterior state of the bodv, 
the constitution, the mode of life accord with the d'siase ; but judicious in- 
terrogation of the patients is the best means of detecting the truth. Wo 
should propose insidious questions— inquire if he experience symptoms not 
at all connected with his disease ; we will seldom fail to find him mentioning 
symptoms that are contradictory, and contradicting his previous statements; 
we should cause the patient to revert to the causes of his disease, to pre- 
ceding circumstances, to the effect of remedies he may have employed. We 
should in such cases, accomplish a most exact and rigorous investigation. 
It is of the greatest importance to examine those functions not submitted 
to the influence of the will : in those diseases which exert an influence upon 
the circulation, (and there are few that do not,) the state of the pulse will 
greatly aid us in detecting imposture. 

If all these means are not sufficient, we may have recourse to painful 
remedies, to a severe diet, sinapisms, caustics, blisters, moxa, &c, or to the 
protracted use of disgusting remedies, &c. 

On the other hand, feelings of self love, of shame or of pride, induce pa- 
tients to conceal their suffering. In our Hospitals the desire for food is the 
most common cause of this kind of dissimulation. In private practice this 
dissimulation leads to many errors ; indeed, it is almost impossible to dis- 
cover a disease, which is concealed from us ; but not so in the hospitals 



*~*- Roslan on Diagnosis. [Auf. 

where the patients are sxibjected so thoroughly and without reserve to ex- 
amination. 

When a patient presents one or more of these obstacles to an examina- 
tion, the physician is reduced to the simple application of his senses. In 
such caser, the reports of persons about the patient are of much greater 
importance than under ordinary circumstances, because the only informa- 
tion we can receive. If Che patient be not blind, we may still derive some 
aid from sig] : : and g< stuies; a gesture imitating the act of vomiting will 
generally make him comprehend that we would know, if he have a disposi 
tion to vomit, &c. The sense of sight will inform us of the exterior habit 
and diseases; the touch, of the temperature, consistence, and degree of sensi- 
bility of the superficial and even of deep seated parts, of the state of the cir- 
culation, &c The ear, of all those sounds discoverable by percussion and 
auscultation. 

Let us, take an ex? mile: — An individual is presented in a state of com- 
plete inconsciousness — so that from him we can obtain no information. We 
can learn only from those about him, that he enjoyed a state -of perfect 
health, and that this accident has suddenly supervened. We resort then 
to our senses and our reason. Wq discover him to be about sixty years 
of age, of a strong constitution, that his. cavities are large and his limbs well 
developed, that his face is red and flushed — his eyes prominent ; the tem- 
poral and carotid arteries beating violently — that the lips are protruded at 
each expiration, that the saliva is frothy, the extremities are cold ; one side 
of the body immoveable, the pulse is strong and hard ; that the patient has 
vomited and has involuntary dejections, that the respiration is laborious 
and stertorous. Do not we see here at once, the seat, nature, and extent 
of the disease, and the therapeutic indications it presents ? 
)U Let us examine : — There is complete inconsciousness. What diseases 
produce this ] They are those of the heart, the lungs and the brain. Is 
it the heart, in this case ? No, for he was previously well and the pulse is 
ijow regular. Is it not syncope ? No, for the pulse is strong and the face 
flushed. Is it asphyxia 1 No, for the respiration and circulation still con- 
tinue, and he has not been exposed to any of its causes. The disease must 
then be in the brain. But the diseases of this organ are numerous. It 
evidently is not chronic; and in coming to that decision, we throw out of 
sight one haif of the cerebral diseases. It remains therefore to be deter- 
mined, whether it be cerebral congestion, arachnitis, ra7nollissei?ient, or 
heniorrhnge. It is not cerebral congestion, for that is a general affection, 
and in tins instance there are local symptoms. For the same reason it 
cannot be arachnitis, and moreover,- it wants the regular course of an 
inflammation in the membranes. It can only be then either ramollissement 
or effusion. But ramollissement producing hemiplegia proceeds slowly, 
hern the accident has occurred suddenly. Hemorrhage alone is thus in- 
stantaneously developed. It then is a cerebral hemorrhage or apoplexy. — 
Let us determine its nature, &c. with still mere precision. As the hemi- 
plegia is of the leftside, the hemorrhage must be in the right lobe. The 
hemiplegia is complete, therefore the hemorrhage is general over the lobe. 
Thus by the application of our senses alone, and our reasoning, we have 
arrived at a knowledge of the nature, seat and extent of the disease before 
us and that with almost mathematical certainty. What more could we 
have obtained from the report of the patient himself.' Now we may de- 
duce Hi*' indications of the treatment from our diagnosis, the strength of 
the subject, the developement of the pulse, &c. Is it not wonderful and tru- 
ly consolatory to humanity, that we can attain to a degree of certainty so 
great, simply by means of our senses and reason? 

After this examination, it remains to advert to antecedent circumstances 
which may have acted as causes, or which may furnish some data for the 
treatment. We should inquire to what cause the patient attributes his dis- 
ease — if it be hereditary or acquired — if it had ever attacked him before, and if 



ih:;6.] 



Ruslan oa Diug/u l 



so, what remedies were used and their effects, [naword, we shouldgive 
our attention to the age, sex, constitution, idiosyncrasy, habits and profes- 
sion of the patient. This constitutes what is called the commemorative 

examination. 

Diseases do not present the same aspect at all periods of the day — we 
must therefore examine the patient, both in the morning and evening, and 
even in the middle of the day. Il is almost unnecessary to remark that this 
kind of rigid examination must be maintained throughout the whole course 
of the disease. 

If the case terminate fatally, the duty of the philosophical physician is not 
yet finished. Behold the moment that nature stands ready to test the judg- 
ment of the physician — to give the formal denial to his diagnosis jf hi were 
mis'aken, or openly to confirm it if true. 

The ignorant and those wedded to systems equally dread this proof; the 
first because it exposes their mistakes — the others because nature uncom. 
plaisant does not minister to their vain systems, but overturns them — hon- 
est nun most heartily seek for it, because it so sheds the light of truth and 
certainty upon medical observations. Of what consequence to the man 
enthusiastically devoted to his profession, and to the happiness of his fellow 
men, if he should be mistaken ) Is he a man and may he not err i It will 
be but a satifaction to the philosophic mind, to have found the moans of re- 
cognizing his error and of rectifying it, and of avoiding it in similar cases — to 
have established incontestably the value of a diagnostic sign, to have glanced 
even at the possibility of introducing certainty into the practice of medicine, 
and thus elevate this beautiful science above all other human sciences — and 
these are the results which may attend upon such examination of the dead 
body. We say it in the face of the bitter raillery of the mediocrity, that 
there is no certainty, but after such examination ; that the observation of 
a case is not complete until it has received the seal of this test. 

This examination of the dead body requires the same care, as the previous 
examination of the patient — nay, it should be more scrupulously execute; 1 , 
for the organs once destroyed before making our observations upon them, 
cannot be again subjected to our notice. 

In France our very abundant resources for this kind of instruction, lead 
us to estimate lightly the immense advantages of post mortem examinations. 
We make them with indifference, and fail to derive from them all the in- 
structions they present to us. With what eagerness and minute attention 
do we see strangers, deprived of these precious resources, prosecute these 
investigations! nothing escapes their observation. IJad Morgngni such 
a variety of s jbjects at his command ? No, and yet how much instruction 
did he draw from those he had ; he overlooked no organ, but examined all, 
and accordingly, what a valuable collection of facts has lie left us ! But 
when we have inspected the diseased organ, and given a passing glance 
at the neighbouring organs, we leave the case, satisfied with such an ex- 
amination. 

If it be of importance to commence the examination of the patient's ex- 
ternal state, it is of still greater to observe this precept in the autopsic 
examination. The size, form, color, temperature, consistence; and often the 
position of the body should be exactly noted. The expression of the face, 
the wounds, contusions, ligatures, ecchymoses, the excoriations, &,c. even 
the accessory circumstances of the clotliing, &e. should not be neglected in 
a case of medical jurisprudence. 

M. Chomel advises to commence this examination at the abdomen. For where 
thi* cavity contains fluids, we can easily then appreciate their quantity and 
quality; and if the chest contain fluids also, we can judge of their quantity by 
the degiee of protrusion of the diaphragm into the cavity of the abdomen. 
The examination of this cavity being completed, we can easily evacuate any fluid 
it may contain. If on the contrary, we begin with the chest, any liquids it may 
contain are sure to flow into the abdomen by the opening necessarily made into 



170 Rostan on Diagnosis. [Auij. 

this last cavity, and there is difficulty in appreciating its cha- 
racter. There exists, during a great part of the year an incon- 
venience, which induces us to neglect this precept, and to com- 
mence the axamination with the head. The examination of the 
brain when carefully made requires much time; now, if we 
commence with the abdomen and thorax, during all tiiis pro- 
tracted examination of the brain, we are inhaling the odour 
from these splanchnic cavities — not merely disagreeable but 
sometimes dangerous. 

All persons most devoted to these examinations feel the want 
of some convenient instrument for opening the cranium, all be- 
ing more or less defective, they all injure or tear the brain or 
its membranes, and thus expose to view alterations which did 
not exist, or destroy those which were present. 

M. Amussat, (who has introduced many improvements into 
vSurgcry, which have been unjustly contested,) struck with these 
inconveniences, invented for this purpose a saw, on one side of 
which is a stop or set, which prevents the teeth penetrating into 
the interior of the cranium : — it does not answer the purpose 
well, because the thickness of the cranium varies at different 
points of its circumference, and especially in different subjects. 
But we still employ, in preference, a kind of hatchet — a ham- 
mer with an obtuse cutting edge, proper for breaking the bones. 
The skull cap being removed, by a circular cut through the in- 
teguments, and by sawing or breaking the bones and tearing from 
the dura mater, we may then observe particularly the state of 
this membrane ? we then make an incision into it at the distance 
of a half-inch from the longitudinal sinus, and carry this inci- 
sion parallel to the sinus, from the crista galli to the tentorium 
on each side ; we afterwards detach the falx this isolated, by 
cutting upon the crista galli; we separate the dura mater from 
the sides, and expose the cncephalon still covered with the 
arachnoid and the j ia matter ; we examine these membranes; 
we expose the cerebral convolutions ; their colour, form, size, 
consistence, their degree of moisture or dryness should fix our 
attention. After this, we cut off by very thin layers, the whole 
of the cerebral mass, and examine each of these parts with 
groat care and note their physical characters. We thus pene- 
trate cautiously into each of the ventricles. 

The brain being examined, the cerebellum demands the same 
degree of attention. We detach the tentorium which covers it, 
we cut the spinal marrow as low as possible and remove it. 
The spinal marrow should occupy our attention last in the ex- 
amination. 

To inspect the thoracic and abdominal viscera, we remove 
the anterior wall of the abdomen, by an incision nearly circular, 
commencing al onehypochondrium descending upon the os ilium, 
following the course of this bone towards the pubis, and asccn- 



1836.] Hostan on Diagnosis. 177 

ding on the opposite side in a corresponding direction, to the other hypo- 
chondrium. Subsequently we extend this incision over the junction of the 
cartilages with their ribs, so far as the anterior articulation of the clavicle 
with the sternum ; we cut through the cartilages ; we then elevate and 
turn the abdominal covering and the sternum over the face, thus bringing 
into view the organs of the chest and abdomen. 

We mark the exterior of the lungs, — their colour, consistence, form — in 
a word, all their physical properties. We regard attentively the pleuras, 
the fluids they may contain, &c. after which we cut into the lungs, then into 
the trachea, the bronchii, and the larynx. We then pass to the examina- 
tion of the heart and its envelopes ; after observing its exterior, we cut 
into its cavities to observe the thickness of its sides. We examine all its 
orifices ; we enquire if any impediments to the circulation exist, and what is 
their nature : with equal care we examine the auricles, and thence open the 
aorta through its whole extent in the chest ; — this operation is generally 
neglected for the veins, but we cannot too strenuously urge it. We then 
pass to the genito-urinary systems. Having satisfied ourselves as to 
their external state, we should open the alimentary canal from the pha- 
rynx to the rectum, by mea:.s of the enterotome of M. J. Cloquet. In some 
cases we should carefully preserve the contained liquids. We should then 
regard the size, colour, consistence, position, &c. of each and every organ 
in the abdominal and pelvic cavities, and we should not neglect the exami- 
nation of the organs of circulation in the abdomen, which may not have been 
examined. 

We then turn the subject upon its face for the examination of the spinal 
marrow. We raise with ease the teguments and large mass of sacro- 
lumbar and dorsal muscles : we then lay bare those portions of the vertebrae 
forming the posterior wall of the spinal canal, and by means of the rachitome, 
an ingenious instrument of M. Amassat, we divide these portions without 
interfering with the spinal marrow ; thus removing all the spinous pro- 
cesses, we bring into view the marrow still enveloped in its membranes ; 
we observe these, cut into them, and remove them for the examination of 
the vertebral pulp itself. There are cases in which the limbs should be 
examined, as also the muscles, the bones, the articulations, the vessels and 
the nerves. It should always be done. 

The method of performing this examination is of little consequence, pro- 
vided we neglect no organ, but examine them all, and particularly that we 
do not ourselves produce accidental lesions, and then mistake them for pa- 
thological developments. 

Whenever we do encounter any morbid alteration, we should regard it 
with the strictest attention, and not abandon until we have a perfect appre- 
hension of it. 

A physician should not confine himself to the interrogation of a patient 
in order to obtain information to direct him in the particular case ; he 
should record his observation, either for the purpose of preserving simple 
notes of interesting facts, or for digesting a memoir for his future use, or for 
publishing his observations for the benefit of the science, &c. The young 
physician, unaccustomed to this exercise, must necessarity experience much 
embarrassment, particularly as the masters of the science have merely left 
us models, without accompanying them with precepts. The art of descri- 
bing a case is a difficult one ; it requires the possession of some very rare 
qualities. Independently of a profound knowledge of his profession, "which 
depends upon himself the physician should possess great sagacity, and the 
faculty of attention in a high degree, and should, moreover, be endowed 
with sensibility, taste, and even imagination. None will deny the necessity 
of sagacity and attention for the physician, but some may ask, why require 
that he possess imagination — that faculty which exaggerates and throws 
such an illusion around its objects ? Because, a cold, unfeeling spectator 
of the ills of his fellow-creatures, mavbe a very exact and attentive observer; 
23 



178 Rostan on Diagnosis. [Aug* 

but one endowed with sensibility — touched with the feeling of those evils, 
which affect not the other, will he not record them with a spirit that vivifies ■ 
his description ! Compare the colourless image of the first with the ani- 
mated picture of the second ! Whence the differing emotions with which 
we receive the descriptions of different physicians ? Why is it that we" 
read with indifference and ennui a history of a disease by one, and with the 
most lively interest that by another; but that the first is destitute of sensi- 
bility, taste, and imagination, for which qualities the other is remarkable? 
No doubt every advantage is on the side of the last in the description of 
their cases. Two pictures of the same object, by two different painters, 
will bear the impress of the genius of each — both may be just, but one may 
be a chef-d'oBuvrey the other a work of mediocrity. In recording a case for 
his own instruction, the observer cannot be too particular ; he should note 
the negative as well as the positive signs. We must then note the morbid 
state and the natural state of ail the organs — of all the functions, and all 
the changes which supervene day by day and hour by hour. But although 
such a description be of value for the physician himself, will it not be tire- 
some and repulsive to the reader ] As the object in recording a case for 
publication is to give as directly as possible, the most exact and just idea of 
the disease, in digesting a case he should commence by discarding all su- 
perfluous details, and should present to the reader the most striking 
features of the disease. 

After a short commemoration as to the age, sex, constitution, profession, 
habits, state of the menstruation, (in females), the suspected cause of the 
disease, the antecedent affections, the exterior state of the body, the physi- 
cian should present the symptoms furnished by the. organ and the function 
disordered. Here we would ask — Is it not preferable to preserve the same 
order in the description of all cases 1 Will we not expose ourselves to con- 
fusion in commencing our description sometimes in one way and sometimes 
in another ] Struck with the prospect of this inconvenience, I at first 
adopted this uniform method ; but I found subsequently, that thus the 
general phenomena, of less importance, were frequently presented to the 
mind, and occupied that first degree of the attention of the reader which 
should have been spent upon the more important characteristic signs ; and, 
therefore, as our object is to convey promptly a just and striking idea of the 
disease, we cannot too soon expose those symptoms which give it individu- 
ality. Of the two inconveniences, I have preferred the less, and adopt the 
method of presenting in the first instance the local, organic and functional 
phenomena, although it necessarily determines some repetition. Having 
presented the principal local symptoms, we should then pass immedi- 
ately to the sympathetic phenomena — to those which the organs furnish, 
that are most intimately connected with those diseased, and successively to 
others more remotely associated. We should be succinct in our narration, 
taking equal care to omit nothing of importance, and to reject everything 
superfluous and unprofitable. When the disease terminates fatally, we 
should follow the same course in our researches upon the dead body— - 
record every fact, positive and negative, for ourselves ; but for the public, 
only what is interesting and profitable. We should note also, the succes- 
sion of the symptoms day by day — the course, duration, and termination of 
the disease, and the results of the post-mortem examination. 

We should always commence the examination of the patient, and the 
description of the disease, at the organ and function diseased or attacked ; 
if many organs be diseased, we commence with the one most seriously 
affected. 

The following table will be found useful in guiding our interrogation of 
the patient, and recording the history of his disease. It is scarcely neces- 
sary to say, that we will seldom or never be obliged in any one case to pro- 
pose as many question- as are fiere 

[The tabic alluded to above will be given in our next. | 



I-S36.] Remedial Powers of the Ceanothus Americanus. 179 



Remedial Powers of the Ceanctlms Americcnvs. Ey Dr. D. II. Kueeard. 

I do not remember to have seen any reference made, (medicinally) to 
the Ceanothus Americanus of Linnaeus, Its sensible properties led me to 
use it in a case of aphttae, tnd subsequently in other derangements of 
mucous surfaces, where I found it of seme importance. Professor Bigelow 
describes the Ceanothus as follows: "Leaves heart ovate, acuminate, 
triply nerved. Panicles axillary elongated. A small white flowering 
shrub, net unfrequent in dry sandy soils. Leaves two or three inches long 
and one broad, finely serrate, and tapering into a long point. From the 
axils of the upper leaves come out leafless branches bearing crowded 
bunches of minute white flowers. These are followed by dry three seeded, 
and somewhat triangular berries. The leaves were used, among other 
substitutes for tea during the American revolution." I might add that the 
dLried leaves and seeds have an odour, when bottled, not unlike the impor- 
ted tea. It has a slight bitter, and somewhat astringent taste. I first 
used it in a case of an old lady of seventy, who had a severe thrush follow T - 
ing typhus. The usual gargles were tried without much effect. Every 
second or third day a new 'coat of darker hue would cover the whole interior 
of the fauces. The mucous membrane after its discharge presented a 
a dark florid appearance, with extreme sensibility. I had tried borax, 
alum, nitras argenti, vegetable astringents and tonics, as gold thread, 
crane's bill, hardhack, oak bark, sumach, &c. without much benefit. The 
Ceanothus growing hear, 1 directed a strong tea to be made of it, w T hich 
acted like a charm ; the thrush soon passed off, and without relapse. 
Since then I have used it largely in aphthae of children, and find it highly 
useful in cases following dysenteria maligna, as well as those of less debility 
and disease, even after other gargles have been ineffectually tried. During 
last March and April, scarlatina, attended in most cases with ulceration 
of the fauces, was very prevalent with us ; I depended almost exclusively 
upon the Ceanothus, with borax for a gargle, and in all but a single case of 
very malignant character, this gargle was effectual. The form I used, and 
which I found best adapted for the cases as. presented, w r as prepared by 
making a strong tea of the Ceanothus, and flowers of the Anthemis Cotula, 
and to a gill add a piece of borax the size of a large pea. I think the borax 
and Mayweed rendered it in many cases more effectual. 1 have also used 
it with benefit in form of a tea in dysenteria of children, and found it fully 
equal in many cases to the Spirea tomentosa. The tea I used was prepared 
from the leaves and seeds. — Boston Med. and Sur. Journ. Sept. 30th, 1835. 

We are pleased to see such articles as the above, brought be- 
fore the public by industrious and faithful observers — articles 
with which our country abounds ; and as valuable as, not to 
say more so, in many instances, than those which are imported 
at great cost and trouble. 

Distance and cost seeming to place a peculiar value on others 
of their kind, whereby we are often decoyed into a preference 
for them ; the bounties of Providence by which w T e are sur- 
rounded are but too often contemned or disregarded. 

The Ceanothus Americanus is one of the most abundant of 
the small shrubs found on our dry sandy soils. In this section 
of the country it is known to all the country people by the com- 
mon names, lied Root, Red Shank, &c. ; and were its virtues 



280 Remedial Powers of the Ceanothus Americanus. [Aug. 

well known amongst practitioners, it is sufficiently abundant to 
be made an article of commerce, of comfortable profit to its pre- 
servers. 

In situations remote from medical aid, and, indeed, in most 
families in the country, it is in constant successful use as a 
styptic and astringent. The observations of many years ena- 
ble us to confirm the remarks of Dr. Hubbard relative to its 
virtues in aphthous affections. 

In thrush in children, it is itself a remedy not inferior to borax, 
which has been so long in universal use. In those cases of 
Fluor Albus which are attended with aphthous eruptions, it has 
been found as uniformly profitable as any remedy of its kind of 
power; and as generally corrective, as abiding and still opera- 
ting causes of this eruption would allow. In those cases of 
Fluor Albus which depend on prolapsus, or descent of the womb 
into the vagina, which constitute no small proportion, there is 
probably not a better astringent lotion in use than its stronger 
preparations, for permanently correcting that relaxation of the 
vagina which exists in these cases. 

In obstinate diarrhoea, the bark of the root has been long in 
successful use. In the troublesome discharge and ulcerations 
of the second stage of salivation, it has been long and success- 
fully administered. The strong decoction of the bark of the 
root, also the bark of the fresh root itself, have been found by 
experience amongst the most valuable styptics in domestic use, 
for restraining haemorrhage from wounds. A tea of the leaves 
and flowers, sweetened with fine sugar, &c. which is not an 
unacceptable offering to the palate and stomach, is finely adapt- 
ed to diarrhoea and relaxation of the bowels generally, parti- 
cularly in children, and those troublesome habitual cases unat- 
tended with febrile action, in which we have reason to appre- 
hend the presence of aphthae, or ulceration, in the mucous mem- 
brane of the intestines. 

It has also been found useful in those highly dangerous cases 
of hypercatharsis induced by the ruinous power of Lobelia in 
the hands of the Thomsonians, and which so often ends in per- 
manent relaxation of bowels and loss of all powers of nutrition, 
and consequent death. 

In such cases, a tea of the leaves and flowers may be very 
advantageously prescribed, more or less exclusively as a diet. 
This tea will generally be found not only admissible, but reme- 
dial in those cases of dyspepsia in which the bowels are perpetu- 
ally relaxed, and the digestive and nutritive functions suspended. 



1836.] Morbid effects of Intemperance. 18 



Morbid effects of Intemperance. Extract from Dr. Hodg- 
kins' Lectures on the means of -promoting and preserving 
Health. 

This work has been lately published in London, and to use 
the words of the British and Foreign Medical Review, is " lite- 
rally /m# of information." We are indebted to the second No. 
of this new work, April, 1836, edited by Drs. Forbes and 
Conolly, for the following valuable extract. Dr. Hodgkms is 
well and advantageously known in England as a Pathologist, 
and is therefore known to speak the language of the truths of 
observation. He is not here advocating the cause of the " Tem- 
perance Reformation" but pouring forth the stores of his obser- 
vation and judgment directly for the 'promotion and preserva- 
tion of health — the noblest effort of the medical man. 

His second lecture contains a great variety of information 
concerning the different kinds of food and drink. The destruc- 
tive effects of spirit-drinking are forcibly dwelt upon, without 
exaggeration, and the following remarks will interest the me'di- 
dab reader. 

"The fatal influence of intemperance in drink, is occasionally seen a little 
beyond the middle period of life, at which time persons are not very nnfre- 
quently subject to what is called climacteric decline. Some are favoured 
to recover from its attack ; but to the spirit-drinker it almost always proves 
fatal. Premature old age is another result of spirit-drinking-. Hiave often 
noticed, with surprise, in the course of my practice, that when I bad suspicion 
of the habits of a patient, and have enquired his ape, that with aJl the 
marks of age and decrepitude upon him, he was some years my junior. 
The habit of spirit- drinking unfits its victimes to bear the wounds, fractures 
and accidents of various kinds to which all are liable ;- and the skill of the 
surgeon is often baffled, or foiled, by the ill condition of his patient, who, 
by a long course of spirit-drinking, has destroyed the powers of his consti- 
tution. It is also worthy of remark, that the spirit-drinker is peculiarly 
susceptible of disease of all kinds, and, consequently, is likely to fall the 
first victim to fevers, or other epidemic distempers. The ravages of the 
cholera have confirmed this by unnumbered proofs. 

" The heart and blood-vessels do not escape the injurious effects of ardent 
spirits. The former is subjected to great varieties of excitement, and the 
palpitations so produced may lead the way to permanent disease. Ossifica- 
tion of the valves, and thickening of the lining membrane, are the probable 
results. The arteries, both large and small, are very liable to become ossi- 
fied ; and when this effect is produced, the individual is very liable to apo- 
plexy and gangrene. In a former part of this lecture, I have hinted at the 
injurious effects which improper drinks may produce on the lungs. There 
is, perhaps, no error of this kind by which this effect is so strikingly produ- 
ced as when ardent spirits are taken. Besides the obvious effect which 
they must have in promoting and aggravating inflammation of the lungs, 
whenever these parts suffer from irritation, at a time when the systenfis 
under the influence of spirits, there are two other modes in which mischief 
is produced, affecting these organs, which are less obvious. First, it has 
been ascertained by experiment, that a greater exercise of respiration is 
re"" ; red when the system is «- -ited by spirit : hence, divers cannot remain 



182 Morbid effects of Intemperance. [Aug. 

so long under water after they have been taking spirits, as they can at other 
times. Runners, also, find their wind shortened after drinking spirits. 
Now those who take spirits in sufficient quantity to afYect the system, and 
then, under the excitement which they have produced, apply themselves to 
some laborious or active exertion, must expose the lungs, or organs of 
respiration, to the chance of very serious injury. The other effect to 
which I allude, may seem at first to be at variance with what 1 have just 
related, as well as opposed to the vulgar or common opinion respecting the 
effect of spirits. It is generalty supposed that they promote the warmth 
of the body : on which account they are frequently taken by persons who 
have no inclination to intemperance, when they are peculiarly exposed to 
cold. This is a very fallacious practice. A transient glow may indeed be 
produced by the quickened circulation which for a short time succeeds the 
swallowing of the dram ; but this afterwards becomes proportionally more 
languid ; in consequence of which the surface, and more especially the ex- 
tremities, become pale and cold, whilst the internal parts are both stimulated 
by the spirit, and loaded with the blood which has left the surface of the 
body. The object of maintaining and equalizing the warmth of the body is 
completely lost ; whilst the internal organs are exposed to the danger of 
inflammation. This effect of ardent spirits is seen carried to its greatest 
and most dangerous extent in Russia, and other countries where extreme 
cold prevails. The inhabitants of these countries are apt to give way to the 
temptation to take spirits to an amount which produces overpowering intox- 
ication. If, in this state, they expose themselves to the cold air, or are 
driven out of dram-shops and turned into it, the combined influence of the 
benumbing cold, and the liquor they have taken, produces a profound degree 
of torpor. ° Breathing, which is closely and necessarily connected with the 
production of animal heat, is almost suspended, and the individual, unless 
rescued from his dangerous situation, is soon frozen to death. 

"The deleterious effect of spirit on the skin, is seen in the production of 
what are usually called grog-blossoms. Spirits, likewise, promote attacks 
of erysipelas, which are often severe, and even fatal, in persons whose con- 
stitutions are shattered by the use of spirits. 

"The Worst effects of spirits, as connected with bodily health, are those 
which it produces upon the nervous system ; by which, I mean the brain 
and nerves. The first effect of a large dose of spirits on this system, is 
almost immediate, and quite notorious, causing swimming of the head, con- 
fusion of ideas, and staggering gait. The late Dr. Spurzheim, who is almost 
universally known, in consequence of the long continued and close attention 
which lie paid to the brain, declared that he had found brains peculiarly hard 
in this country, which he attributed to the general abuse of spirits. A stri- 
king, and often immediate, effect of intoxication, upon the brain, is apo- 
plexy. When this is not immediately fatal, palsy is almost sure to remain. 
Epilepsy is another very serious disease of the brain, which, when not pro- 
duced, maybe greatly aggravated, by the influence of spirits. In females, they 
greatly promote a tendency to hysterics. One of the most serious diseases of 
the brain, brought on by the use of spirits, is called delirium tremens. Per- 
sons, wl lose age might induce one to suppose that they were in the prime of 
life, arc Bometimes carried off in a few hours by this dreadful malady. Those 
are the most liable to die from this affection, who have kept up an almost in- 
cessant state of excitement by means of ardent spirits. It is not necessary 
that the quantity taken should have been such as to produce an extreme 
degree of intoxication. The individual may even have been able, in some 
degree, to attend to the various concerns in which he might happen to be 
placed ; when, after the sudden removal of the stimulus, or the abstraction 
of blood, or some powerful influence on the mind, or sometimes without any 
assignable cause, a state approaching to madness, and often marked with 
tremors, muttering, and prostration of strength, suddenly comes on, and if 
not pretty promptly relieved by well-directed medical aid, is very apt to 
prove speedily fatal." 



1830.] Medical application of Galvanism. 183 

Part III.— MONTHLY PERISCOPE. 
Medical Application of Gahanism. 

Wc learn by the Boston Medical and Surgical Journal of 
29th Jane, that Dr. Page, of Salem, has lately contrived 
a modification of Professor Henry's apparatus for obtaining 
sparks and shocks from the Calorimoter, which, he thinks, 
must supersede all other instruments at present in use for the 
application of galvanism in cases of paresis, &c. He does not 
give a particular description of the apparatus, but merely an- 
nounces it, on account of the interest it promises to the profes- 
sion. By a self-regulating apparatus, the shocks may be made 
to succeed each other with almost any degree of rapidity and 
strength. The sensation thus produced, he says, is quite unlike, 
and less disagreeable than that from the deflagrator. He be- 
lieves that it will also undoubtedly prove a superior instrument 
for the application of M. Pakbrat's discovery for the transmis- 
sion of medicinal substances through any part of the body, by 
galvanism. 

We look with pleasure to the day when galvanism will be- 
come one of the most important and agreeable agents at the 
command of the practitioner for the regulation of excitement. 
especially local excesses and deficiencies. We have witnessed 
for many years its decided power of lessening action at one 
pole and increasing it at the other — thus proving its power of 
translation or revulsion. So decided is this power, that when 
properly adjusted to two blistered or denuded points, the blister 
at one pole will desiccate, whilst the other will inflame and 
secrete copiously; and in some cases, finally sphacelate. In 
view of this fact, the Medical Society of Augusta, at a recent 
session, offered a premium of fifty dollars for an apparatus for 
the convenient application of galvanism to the purpose of re- 
vulsion in the treatment of disease. We can form no distinct 
idea of the apparatus of Dr. Page, as he has given us no descrip- 
tion. We trust, however, that the article itself, or a competent 
description of it, will soon be forthcoming, and, for the credit of 
the profession, unimcumbered by the price of a patent right ; or, 
should the right of use be restricted by a patent, that the privi- 
lege will not be offered at such a price as will amount to a pro- 
hibition of its use in the service of humanity. Such is the case 
with regard to several new inventions recently and at present 
offered to the public — amongst which we will name trusses, gal- 
vanic apparatus for medical purposes, &c. &c. many of which 
are put at from five to fifty times the value of the article from 
the hands of the makers. This wc look on as an outrageous 



184 Medical Application of Galvanism. I Aug. 

ftbuse of patent protection, the object of which is mainly to hold 
out an inducement to genius and industry, that divers good pur- 
poses may be answered, as saving of labour, economy in the 
expenditure of money, accomplishing new and important pur- 
poses, &c. But there is an avaricious disposition in most men 
which will make them reach just as deep into the pockets of 
others as any device can enable them to do; and we regret that 
there are instances to be found in the profession of medicine, 
where charity and benevolence should characterize every move- 
ment and purpose. O ! it is one of the most nauseating drugs 
in all the routine of operations of medical men — it operates by 
the ears, and sickens the heart, to hear a medical man say, (and 
we have more than once heard such,) " they will not hesitate to 
give any price, when pain afflicts or death threatens," or " I 
must put the price thus high, that I may be able to give to the 
poor who cannot buy," and still the poor who are thus supplied, 
are never to be seen or never heard of — thus contending for 
such prices as ten, fifteen, twenty, thirty, or perhaps one hun- 
dred dollars for an article, the manufacture of which is only 
worth from fifty cents to two or three dollars. Thus are the 
very purposes for which patents w r ere created, subverted. 
The invention, suppose it the least in the world, is put beyond 
the reach of all prudent and economical persons ; or they arc 
forced by torture or danger to squander their fortune in search 
of relief, and become tributary to the insatiable avarice of some 
inventor, and perhaps impostor. Thus does state protection, 
instead of securing to the good citizens the benefits of improve- 
ments and discoveries, actually debar the benefits for fourteen 
years, and protect the insatiable avarice of the patentee, even 
notwithstanding the same discovery may have been made by 
others. These remarks are applicable to the principle of patents 
generally. But what shall we say of patents for the exclusive 
right of things demanded in the service of humanity, used for 
purposes of rankest extortion ? If life depend on the use of the 
article, and the high price debar the use, (because it is unlawful 
for any other than the patentee to vend or use, without satisfy- 
ing the patentee,) then the patentee becomes the cause of death, 
and the state the protector of his inhuman and criminal avarice. 

It is a glorious truth, that such examples are rare in the pro- 
fession, and never to be found with those highminded and honor- 
able members who are properly classed in it. It is only a few 
of the sordid and mercenary, who would sell alcohol by the half 
gill, or spread the smallpox virus, if they could make money by it. 
" The virtue that needs guarding is not worth keeping." The 
truly benevolent cannot limit their usefulness in the cause of 
humanity, by sheltering their own individual interest, against the 
general weal. 

We would suggest this improvement or amendment of the 
patent law : that in all instances the patentee be compelled to 



1836.] Extract of Belladonna. 185 

forfeit his right, on being convicted of selling or offering his in- 
ventions at more than double the price at which they are manu- 
factured; or of pricing his right of use at more than the price at 
which the article can be procured of the manufacturer. This 
would afford an inducement as effectual in promoting industry 
and the exercise of genius as the present, without legalizing 
cruel and inhuman privations on one hand, or feeding an insa- 
tiable and misanthropic avarice on the other. It is to be hoped 
that it will not be long before those patents which are for useful 
articles will be superceded by improvements on the present 
patents, (a thing almost always easily done,) and the benefits 
then taken into the hands of professional men of sound and 
honorable principle. 



Extract of Belladonna preventive of Scarlatina. — A part from 
Homseopatheia, the German physicians continue with increasing 
confidence to look to the use of Belladonna for the prevention 
of Scarlatina. They use it in the form of a solution of two grs, 
of the extract to the ounce of water. Professor Fleischmann 
has recently used it in fifty-two children, during the prevalence 
of Scarlatina for about five weeks. Forty-eight of these esca- 
ped the disease. It was given in doses of one drop for each 
year of the age of the child in all cases ; and even in this small 
dose, (which, however, seems Homceopathic,) the symptoms of 
the action of Belladonna were observable in twenty-three cases. 
It is believed by the professor to counteract the contagion,* di- 
minish the susceptibility without entirely removing it; and 
give a mild character to the cases which do occur notwith- 
standing its use. 

We regret that Professor F. did not state what proportion of 
the children who did not use this prophylactic, suffered by the 
disease ; for without this, the testimonial in favour of the pro- 
phylactic virtues of Belladonna is nugatory. When a few hun- 
dred cases of fever occur in a community of many thousands, 
they strike the attention with great force. But the thousands 
who escape are not thought of. A practitioner in full business 
may lose half a dozen patients ; another of small business may 
lose one or two. The latter plumes himself on his success, in 
having lost but one or two cases, whilst the former has lost 
several times that number; — the positive number lost in each case 
is only thought of, not the relative proportion; and the latter is ex- 
alted in the community for his signal success, and the former pro- 
claimed " very unfortunate ;" whilst the relative ill success was 

* The existence of this kind of extrinsic cause is yet a subject of much 
doubt. 

24 



186 Extract of Belladonna. L^ug. 

with the former, as one to a hundred; and that of the latter, as one 
to four or five. Thus it is, that improper estimates are often and 
most unintentionally formed. We apprehend that it is not a very 
easy matter to form a correct estimate of any active preventive 
means. Certainly it is preventive, to withhold " causa? noxia3." 
There are also within our knowledge noxious causes which are 
susceptible of chemical correction, whereby their active powers 
are neutralized and destroyed. We know also of the preven- 
tive value of avoiding predisposing and exciting causes ; and 
the great science of Hygiene consists mainly in the knowledge 
of noxious causes ; and the practice of it in avoiding them. 
It is, therefore, in a certain sense, rather a passive than an active 
science. But here, causes, and their modes of acting, are 
known, and their application generally avoidable ; and most 
commonly indeed, require voluntary effort to secure their ap- 
plication. The case is very different with regard to Scarlatina. 
Even the fact of its contagiousness is by no means satisfactorily 
determined. And certain it is, that if it depend upon contagion 
for its cause, that contagion has laws entirely different from the 
generally admitted laws of contagion ; or it has no laws at all ; 
and if it has no laws, or peculiar characteristics in its mode of 
action, it has no qualities at all ; for it is only by the effects that 
wc have any knowledge of contagion whatever ; and there- 
fore there is no such thing. If, however, it depend on a conta- 
gion with peculiar laws, these laws are not known. There is 
therefore no knowledge of the cause, and without some know- 
ledge of the cause, no active means can be directed to preven- 
tion on rational, or other than merely imaginary grounds. 
In such a case, it is only accident, or unguided experiment, 
which could be expected to develope the fact of a preventive 
power in such a case. When done, the truth depends, for its 
reception, on the strength of the evidence of the fact. If, there- 
fore, professor Fleischman had made it appear that a conside- 
rably greater proportion than eight out of one hundred children, 
under precisely the same circumstances in all respects, except 
the use of the Belladonna, took the disease, and this, in re- 
peated experiments alike fairly made, then, and not until then, 
could we have consented even to coincidence, much less to cause 
and effect in the premises-. We believe in the possibility of pre- 
ventive or ameliorating means for this disease ; but we believe 
they are not likely to be revealed until the view of the disease 
is extended to a plurality of causes — the want of which gene- 
rally, we look to as one of the greatest errors in pathological 
reasoning. Certainly there are few, if any, effects without more 
causes than one, and this doctrine is as applicable to pathologi- 
cal as to any other phenomena. If, therefore, preventive as 
well as curative indications do not embrace a proper relation to 
all the causation in the case, they must be essentially and radically 



1830.] Animal Magnetism. 187 

defective ; as causes must be withheld if effects are to be pre- 
vented ; and removed for their correction, if these have been 
produced. 



Animal Magnetism. — M. Poyen, lecturer on Animal Mag- 
netism in Boston, has lately translated the report of the Mag- 
netical experiments made by the commission of the Royal Aca- 
demy of Medicine of Paris, read in the meeting of 28th June, 
1831, by M. Husson, the reporter. He has preceded the trans- 
lation with seventy-one pages of introduction, or prefatory 
remarks, which are said to add great interest to the work. 
The whole taken together, forming a duodecimo volume, pub- 
lished by D. K. Hitchcock, is said to comprise the whole of the 
present state of knowledge on this curious subject. 

It is not a little strange, that thosevery respectable physicians, 
at the head of the profession, who have from time to time 
observed the operations of magnetizers,and the phenomena which 
are declared to have followed these operations, should not long 
since have determined the fact of the truth or falsehood of the 
matter. It does appear to us that there is something of scientific 
cowardice, (if we may so speak,) prevalent in relation to this 
avowed power. How should Cloquet, for example, agree that 
the magnetizer should exert his powers in preparing a woman 
to have her breast amputated, without any pain w r hich should 
make her sensible of the operation — then operate, without the 
least manifestation of pain, or consciousness on her part, of what 
was passing, and without knowing, after being de-magnetized, 
that the operation had been performed, until told of it — report 
these things to the Academy as incidents which he had witness- 
ed, and not determine whether there was in it the operation of 
cause, and the production of effect, and give, at once, the whole 
weight of his character to prove that there was, or that there 
was not truth in the thing ? It may be considered noble, to ac- 
knowledge before the Academy, (mainly a body of unbelievers 
in animal magnetism) the facts he witnessed, being himself an 
unbeliever. But this we cannot think, unless truth has become 
a most rare commodity ; for it is the most common-place duty in 
science to tell the truth. Could it be said that Cloquet acted 
nobly because he did not tell a falsehood and deny the truths he 
had witnessed, or, that he did not conceal them, when he that 
would do either must be beneath all consideration ? For this, 
he was entitled to about as much credit as the man would be 
who should borrow his friend's horse, and return him with ac- 
knowledgments of the favour, instead of stealing him and 
denying having seen him. Was M. Cloquet a complete Dr. 
Doughty ? If so, he should have said to the Academy, " I see?n 



IS8 Animal Magnetism. [Aug". 

to have operated for the amputation of a female mamma, and 
the woman seemed not to know when it was done. And it 
seemed to me that the magnetizer offered to bring her into a 
state of insensibility, preparatory for the operation," &c. " but 
all things are doubtful — all things uncertain." 

But we may come nearer home. Mons. Bugard, in Boston, 
undertakes to so magnetize his pupil, a little girl twelve and a 
half years old, as to prepare her to undergo the extraction of a 
molar tooth, without the least pain. Dr. Ware extracts the 
tooth — the girl does not feel it, and is only conscious of it by the 
blood found in her mouth afterwards, and by the vacancy in its 
place. Present, Professor Tradewell, of Harvard University, 
and Drs. Harwood, Lewis, Hodge, &c. &c. — a long scene is 
exhibited in which all play a part — and the whole is left to be 
told by a medical student only. Where are the Doctors ? Why 
have they not ventured on this matter I Have they preferred 
to have a man between them and the rope 1 Have they been 
disposed to make the medical student the scape-goat ? Or a 
pioneer, to fall by the first shot — saving themselves ? Or is 
Mr. West the only man of the party who has the independence 
to declare what he has witnessed? 

If there be truth in this thing, (and if there is not, why do not 
those whose names are connected with these phenomena, 
promptly and effectually correct misstatements ?) if there be 
truth in the thing, we say, there is no necessity before we ac- 
knowledge the truth of the power, that we understand the whole 
minute philosophy of it. This unknown philosophy, remains a 
subject of most interesting enquiry. We do not hesitate to own, 
when we see the time indicated by the hands of a clock, that 
the clock truly has the power of keeping and shewing the time, 
although we may be ignorant of the precise mechanism whereby 
this end is effected. When we see a man perform the various 
functions of life, we believe in the existence of life, although we 
may have no idea of the internal organization. We have ac- 
knowledged the existence of life in all generations, and no man 
has yet told us what it is ; but we have owned its existence 
because we have witnessed its effects. For our own part, we 
regret to say that we have never witnessed the operations of 
the magnctizers, but think we could scarcely fail to determine, 
on doing so, whether there was or was not cause and effect, 
even if we could not comprehend or detect the cause. Events 
themselves declare cause, with most unequivocal certainty. 
There is no phenomenon cognizable to man, through the medium 
of his senses or otherwise, which he docs not intuitively and at 
once acknowledge as the effect of competent causation, however 
it may be calculated to overwhelm his powers, by its grandeur, 
or elude their search by its minuteness. Is the influence of one 
man over another by the way of what are called magnetizing 



1836.] Animal Magnetism. ISO 

operations, more incomprehensible than the elementary constitu- 
ents of those microscopic animalculse which are only broughl to 

our perception by glasses which magnify a million times — their 
minute organization for locomotion, nutrition, sensation, &c. ; 
or than the vastly incomprehensible universe ? And can we 
extend even our imaginations to the contemplation of either, 
without at the same time acknowledging the cause ofalll Oar dif- 
ficulty is not here. When we place a man of one or two hun- 
dred pounds on a table, and raise him on the points of the index 
fingers of four men, without a sense of more weight than a few 
ounces or pounds at most; or when, on thus raising him he 
leaves the fingers and ascends higher, we know at once that 
there is antecedent and sequent, and cannot hesitate to acknow- 
ledge it. But if a like sequent uniformly follow this antecedent, 
we are compelled by an unavoidable law in reasoning to ac- 
knowledge causation, and competent causation ; for such is the 
obtuseness of the human intellect, (at least of ours,) that we can 
perceive or comprehend no more minute knowledge of cause 
and effect than that of their being different phenomena which 
uniformly occur in the same relative concatenation. This truth 
established, and there is no resting place for mind, short of de- 
termining the latter link consequential. But there is no effect 
without cause ; therefore the existence of effect proves cause. 
Our doubts on this subject, then, only extend to the history of 
this concatenation ; and are only founded in the difficulty, com- 
mon to the human mind, of allowing that of which we have no 
distinct idea, or which differs entirely from any thing the mind 
may before have comprehended or contemplated ; as of forms 
or powers not before presented to our senses or intellect. 
We hope to witness these things ourselves, or receive the 
high testimony of men at the head of science — then we shall 
feel no difficulty in venturing our faith on the unerring laws of 
rational argument. 



Chloride of Soda for Sore Nipples. — Dr. Chapm, in a memoir in the Ga- 
zette Medicate de Paris, says, that of all the means recommended for the 
cure of sore nipples, nothing has so well succeeded in his hands, as frequently 
repeated lotions with Chloride of Soda. In one or two days, he says, it 
will often effect a cure. — Amer. Jour. 



190 Morisorfs Hygeian Pills. L-A-ug. 



Morison't Ilygcian Pills. 

To the Editor of the Boston Medical and Surgical Journal. 

Sir, — Seeing an account, in one of your late numbers, of the death of a 
patient from the use of Morison's Hygeinic Pills, I am induced to send you 
the following notice of them from "Colton's Four Years in Great Britain." 
Prom the closing observation it is not to be wondered at that numerous in- 
dividuals have paid for their credulity with their lives. Is it not astonishing 1 , 
that while the nations on the continent of Europe have suppressed by law 
the vending or advertising of such patent medicines, Great Britain and the 
United States, those two enlightened and liberal governments, should pa- 
tronize them to an extent almost beyond human calculations 1 The auri 
sacra fames seems to be here predominant over life itself. 

S. W. Williams. 
Dscrfeld, Mass. March 19, 1835. 

"The celebrated empiric, Dr. Morison, pays to the government of Great 
Britain upwards of 7000 pounds ($33,600) a year, in the way of tax of three 
halfpence on each pill box. His boxes are of two sizes ; and retails one at a 
shilling, and the other at sixpence. Suppose he sells an equal number of box- 
es, which would make the average per box eight pence ; allow for tax, mate- 
rials and making of the pills, and discount for the trade four pence, the net 
profit to himself would then be £37,668, or $180,793 annually ! The pro- 
fessional practice of Mr. Brodie, Saville Street, Serjeant surgeon to the king, 
has been stated by creditable authority to be £15,000 or $42,000 a year. 
In reputation as a surgeon, Dr. Brodie is only second to Sir Astley Cooper. 
How much more profitable is empiricism than science and art, and some of 
the greatest fortunes in Europe have been made by the manufacture of 
boot blacking. What a quantity must have been sold in London, to afford 
an advertising bill for Warren's blacking of £250,000, or 1,200,000 dollars, 
annually. Yet such is the fact. 

" Sir John Long's recipe was left sealed by him, price ten thousand pounds, 
not being opened before bought. It has been taken on the terms of his 
will ; — a pig in the poke. 

" It has been ascertained that the careless and imperfect mixing of the 
ingredients of Morison's pills, often leaves the powerful agents in one part 
of the mess, before it is made into pills, which kills those who happen to 
have a box of that portion — while the rest maybe swallowed with as much 
impunity as so many bits of dough from the kneading trough." 

[In connection with the preceding from our correspondent, we beg leave 
to present the following remarks by Dr. Jolmson, editor of the Medico- 
Chirurgical Review.] 

Scarcely a day passes without instances occurring of a serious mischief 
from the preposterous use or abuse of this quack medicine ! These 
events, however, make but a very trifling and local impression on the few 
who become acquainted with the facts of the case. It is only when a judi- 
cial inquiry takes place, and the attention of the public is attracted to the 
subject, that much check is given to the suicidal consumption of the nostrum 
in question. We have good reason to believe that the manufacture of 
♦'Morison's pills" has experienced a considerable diminution by the late in- 
questand trial at Manchester. We are disposed to think that a blow of 
no small force has, si ill more recently, been given to the preposterous man- 
ifestos of the Ilygeist, by the inquest in Clarence Gardens. 

There can be no doubt that this verdict was correct. Not that we sup- 
pose there is any ingredient in this nostrum of a poisonous nature ; but that 
the venal recommendation to employ the pills in all diseases, leads to such 
an indiscriminate ingurgitation of tliem, that a certain per centage of death 
must be the inevitable result. 



183G.] Thomsmdan Practice, eye. 101 

Here lies the great moral responsibility ! What a self-immolated host of 
victims must greet the ilygeist on the banks of Styx, and deafen old Charon 
himself, while wafting the affrighted ghost to the regions of Tartarus ! Poor 
Mr. M'Kerrel narrowly escaped a verdict of Felo-de-se, for taking Prussia 
acid ; and yet thousands of infatuated people, in this country, are not con- 
sidered insane, although they swallow quack medicines which are certain- 
ly fatal as, though far more painful in operation than, Prussic Acid ! 

" Quern Dcus vult perdcre prius dementat." 

The verdicts on such occasions, ought, strictly speaking, to be — "Suicide 
committed during temporary insanity respecting Morison's pills." — Boston 
Medical and Surgical Journal. 

TJwmsonian Practice. — "A correspondent in Connecticut gives us the 
following particulars of a case which recently came under his notice. 

Miss E. Fox, aged about 30, had been subject to slight epileptic fits for 
about two years, occurring irregularly, sometimes as often as once a month, 
and sometimes not oftener than once in two or three months. She was 
importuned to take the advice* of a Thomsonian in Hartford, and had been 
under his care about a week, when she died, immediately or very soon after 
coming out of the hot bath. Mr. Fox, her father, informs me that he saw 
her on the day before her death, and that she expressed a wish to return 
home, but concluded to stay and be cured, and that he could not learn the 
particulars of her death, but the doctor said the fits killed her, for on coming 
out of the bath she had six or seven in succession, till she died. It is re- 
ported also, that after the bath she had the cold dash and the lobelia 
emetic, and that she died in the operation of the latter. I believe she had 
never persevered in a judicious course of medicine, though she had been 
very much benefited last winter by taking stramonium seeds, recommended 
by a person not a physician. She however took them in such large doses 
as soon to cause confused vision, and they were consequently discontinued ; 
but the fact itself of the improvement shows that she might very easily have 
been cured under proper treatment. One of the many soi-disant philan- 
thropists of the present day, who had had the ThomsGnian practice in his 
family, and who was busy in recommending it to others, once told me — 
what he seemed to believe — that the Thomsonians could give a man an 
emetic immediately after he had eaten a hearty dinner of beef-steak, and 
that the emetic would clear out all the bile from the very bottom of the sto- 
mach, and yet the beef-steak should remain unmolested. This man was not 
a fool, but knew enough to get a living in the town of East Windsor, Conn. 
Such people seem to have for theirmotto, " Credo quia impossibile est." — ib. 

Illustrations of Surgery. — A splendid set of Illustrations of 
Surgery is offered to the public by A. S. Doane. We have 
withheld a notice of this work for some time, in the hope that 
we should be able to speak of it from our own inspection. But 
as we are not yet so fortunate, we are only able to say that it 
is compiled from the writings of Gerdy, Hard, Velpeau and 
Blasius ; sources which, with the assurance the public possess 
of Dr. Doane's zeal and talent in this mode of communicating 
practical knowledge, may be considered surety for great use- 
fulness of the work in the hands of every student, practitioner, 
and teacher of surgery. 



192 Mechanism of the Bruit de Soufflet. [Aug. 

The first five plates are devoted to bandages. The next 
twenty to fractures, and the remaining twenty-live or thirty to 
illustrate the principal surgical operations. 



Mechanism of the Bruit de Soufflet. 

Ill the second part of Dr. Corrigan's Memoir, read to the 
Medical Section of the British Association, at the Dublin meet- 
ing, we are presented with his views of the Mechanism of the 
Bruit de Sou!flot, which are as follows : 

"The sound depends on the simultaneous presence of these two conditions, 
viz: 1st, a current-like motion, of the blood (instead of its natural equable 
movement,) tending to produce corresponding vibrations on the sides of the 
cavities or arteries through which it is moving ; and, 2ndly, a state of the 
arteries or cavities themselves by which, instead of being kept in a state 
of tense approximation on their contained inelastic blood (which would ne- 
cessarily prevent any vibration of their sides,) they become free to vibrate 
to the play of the currents within on their parietes ; and by those vibrations 
cause, on the sense of touch, "fremissement" and on the sense of hearing, 
"bruit de soufflet." It was shown that these two conditions are present, 
in the parietes of the ventricle, and the currents of blood striking against 
them in cases of narrowed auriculo-ventricular openings ; in the enlarged 
and tortuous arteries of the placental portion of the uterus permitted by 
their very free anastomosis with veins and sinuses, and other causes, to be- 
come partially flaccid in the intervals of the heart's contractions, and the 
irregular currents necessarily assumed by the blood in rushing along these 
comparatively flaccid tubes at their next diastole ; and that similar condi- 
tions exist in the analagous state of the vessels in aneurismal dilations of 
tortuous arteries. The presence of the two conditions was also applied to 
explain the mechanism of the sound in permanent patency of the mouth of 
the aorta, in the large arteries of animals dying of haemorrhage, and in va- 
rious other instances. In conclusion,, two experiments were detailed, in 
which, in one instance, a small bladder, and in the other a portion of the gut 
of an animal, was interposed between two cocks, the upper or nearer being 
the cock of a water-cistern, and the lower or further constituting the dis- 
charging orifice of the bladder or gut, and water then allowed to flow 
through from the cistern. The sound "bruit de soufflet" and the sensation 
"fremissement" were perceptible in the intervening bladder or gut, untd 
(from the upper pipe pouring in fluid faster than the lower discharged 
it) the bladder or gut became tense, and then both sensations ceased, the 
passage of the fluid through, nevertheless, continuing all the time. The 
experiment with the bladder was applied to explain the occasional presence 
and absence of "bruit de soufflet" 'in aneurisms, the sound being present in an 
aneurism when, from any circumstance connected with it, its parietes can 
become at all flaccid in the intervals of the heart's contractions, — not being 
heard if the parietes remain tensely applied to their contained fluid. 



SOUTHERN MEDICAL, 



AND 



SURGICAL JOURNAL 



Vol. I.] SEPTEMBER, 1836. [No. 4. 

Part I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

A case in which the Placenta was retained thirteen days after 
delivery at the fall term — with recovery. By Geo. R. Grant, 
of Jefferson, Jackson County, Ga. 

The separation of the placenta, is always considered by good 
accoucheurs, as the most important stage of natural labour. — 
We will not trouble the reader with extensive quotations, or 
multiplied references, to prove, what we are well aware, will 
never be denied by those who fully understand the subject. We 
freely accord with the following sentiment of Dr. Gooch ;•■ — 
" You generally find (says he,) that patients estimate their dan- 
ger only by their sufferings ; hence, as soon as the child is born 
their anxiety ceases ; but if they knew the dangers attendant on 
the separation of the placenta, their apprehensions for their 
safety would scarcely terminate so soon."* 

It is a strange and interesting fact, that so few females fall 
victims to a process, confessedly fraught with dangers of the 
greatest magnitude. In no one of the operations of nature is 
the wisdom and the goodness of God more clearly illustrated, 
or the wise adaptation of the cause, to the effect, more evident 
than in the subject under consideration. 

1 Gooch'tj Midwifery, page 146. 



194 Remarkable Retention of the Placenta. [Sep?, 

The principal danger to be feared from a retention of the 
placenta is hemorrhage ; which may be produced by a partial 
separation of it from the uterus, leaving open the mouths of a 
few bleeding vessels ; or it may be entirely detached, and re- 
tained within the cavity of the organ, from rigidity of the os 
uteri, or other causes, its bulk preventing the degree of con- 
traction necessary to close the extremities of the bleeding ves- 
sels. A case of the latter description having lately fallen under 
our notice, we offer it more for the circumstance of its long 
continuance, than for any thing else new or surprising, connect- 
ed either with the case, or its treatment. 

Mrs. D., of this county, was delivered on the 12th of May 
last, in the evening, of her first child. Nothing unusual occurr- 
ed during the accouchement. The labour, for the first one, 
was considered by the midwife, easy and expeditious. Imme- 
diately after the child, followed the entire chord, which had 
given way close to the placenta. The cord breaking thus early, 
and the placenta not coming away, after waiting several hours, 
the midwife being alarmed at an occurrence so unusual, advised 
that a physician should be sent for ; and the services of Dr. 
Wellborn, who resides in the neighbourhood were engaged. — 
The doctor made several efforts to extract the placenta, which 
proving abortive, he had recourse to ergot, which was adminis- 
tered regularly during the night, with the effect of inducing se- 
vere and continuous uterine efforts, but without producing the 
desired effect. On Friday, the 13th, Dr. Wellborn left Mrs. 
D. with strict orders to the nurse — the midwife — to keep the 
patient's bowels open with castor-oil, and to continue the ergot 
at stated intervals. The ergot was continued, as directed, until 
the pains became so intolerable, and the patient so restless, as 
to induce the nurse to believe, " that the woman" — to use her 
own expression — would go into fits ; and she discontinued the 
medicine. Nothing more was done until Sunday evening, the 
15th, when Dr. W. was again called in. Finding that the ergot 
had not been used according to his direction, he again prescrib- 
ed it, with the same effect as before, namely, severe uterine pain 
without expulsion. Seeing himself foiled in this, his only seem- 
ing resource, Dr. W. advised a consultation, and I was sent for 
between midnight and day. I arrived early on Monday morn- 
ing, the 10th, and the fifth day of the patient's suffering, and 



IR3G.] Remarkable Retention of the Plaeenta. 105 

learned from the doctor, the foregoing history, with the addi- 
tional fact, that the patient had had a slow but continual he- 
morrhage from the beginning. 

Mrs. D's general appearance was truly alarming ; her coun- 
tenance was expressive of severe suffering, the ergot produc- 
ing almost constant grinding pains ; her pulse was frequent, 
weak and corded, and her abdomen exquisitely sensitive. The 
tumour produced by the retained placental mass, could be dis- 
tinctly felt through the abdominal parictes; the slightest pres- 
sure on it could not be borne without intense pain. To satisfy 
myself of the condition of the os uteri, and to ascertain if ex- 
traction were not still practicable, an examination was proposed 
and consented to, not without great reluctance, however, on the 
part of the lady ; and who could blame her ? as the parts 
had become extremely tender from frequent examination, and 
the irritating quality of the discharge. My left hand was placed 
on the abdomen, immediately over the tumour formed by the 
placental mass, and the pressure gradually and gently increased 
until it was sufficient to push the tumour from the right iliac 
fossa where it was situated, towards the symphysis pubis. — 
Having secured it there, the index finger of my right hand was 
introduced, per vaginam, slowly and cautiously. The com- 
plaints of the patient were boisterous during this stage of the 
examination, and when my finger reached the os uteri her ago- 
ny seemed very great. I examined it, however, in the most 
gentle manner possible ; — found it tumefied, its lips thickened, 
closely approximated and rigid. My object was, if I had found 
the os dilatable, to have gently opened it with the fingers of my 
right hand, — to have borne down the retained mass with my 
left from the pubis, where I had it confined, towards the vagina, 
and extract it if possible. The condition of the parts rendering 
this impracticable, the examination was discontinued. As pu- 
trid portions of the placenta were being discharged continually 
with the blood, and other fluids from the uterus, the smell which 
I encountered during the examination was, to say the least of 
it, superlatively foetid. 

I proposed to Dr. Wellborn, to give the patient a full dose of 
laudanum to ease the pains produced, and still kept up by the 
ergot which had been administered ; and that a broad bandage — 
which had been neglected — should be applied to the abdomen ; 



196 Remarkable Retention of the Placenta. [Sept. 

gradually and gently tightened, as the patient could bear it, un- 
til it afforded the necessary support. These means had a ma- 
gical effect over the uterine contractions, and the abdominal 
tenderness. Mrs. D. expressed her feelings of comparative 
comfort, in strong terms, shortly after their application. 

In the consultation we advised that no more ergot be used, 
and no further efforts at extraction be permitted, at least for the 
present. The course of treatment advised was the following, 
namely : That the parts be kept clean by injections of strong 
chamomile tea, containing half an ounce of chloride of soda to 
the pint. These injections were to be frequently repeated, and 
used moderately warm. The bowels were to be kept open by 
pills composed of equal parts of aloes and rhubarb, with a small 
portion of tart, antim. — one-eighth of a grain to the pill — one to 
be taken three times a day; and if that number operated too 
freely on the bowels, the dose to be reduced to two, or even one. 
in the twenty four hours ; the object being to procure one or two 
consistent evacuations daily. The tinct. sulphuric, acid, aromat. 
was recommended in small and frequently repeated doses, to 
betaken in sweetened water sufficient to moke a pleasant acid 
drink. The diet to be light and nutritious. The patient's head 
and shoulders were to be kept elevated to assist the escape of 
the foetid discharges ; and her friends were requested to 
give information on the slightest recurrence of unfavorable 
symptoms. Dr. W. agreeing to this course, and the necessary 
instructions having been given to the lady's friends, we sepa- 
rated. 

Dr. Wellborn examined Mrs. D. on the seventh day after the 
consultation — as I have been informed — and from the entire 
absence of putrid smell, and hemorrhage, and other attendant 
circumstances, pronounced her clear of every particle of the 
placenta. This, however, proved not to be the case, for on the 
fourth day after his examination, a large mass, the remains of 
the old placenta, was discharged: both mother and child are 
doing well. 

Remarks. — The most remarkable circumstance connected 
with the foregoing case, is the great length of time — thirteen 
days — during which the placenta was retained. That it was 
detached from the uterus, immediately after the birth of the 



1836.] Fracture, $c. cf Cervical Vertebra. 197 

child, we have every reason to believe. The midwife says she 
could feel it before Dr. W. was sent for, but was afraid to ex- 
tract it. Dr. W. says he felt it, and hooked his finger into it, 
but could not bring it away, because of the crippled situation of 
his hand, having lost most of the fingers from his right hand 
when a boy, by the saws of a cotton gin. Might he not have 
introduced his whole hand, into the uterus, and then been able to 
bring away with it, the placenta ? " A man must have the hand 
of a giant," says Gooch, "if it will not pass through the space 
which has just admitted the descent of the child." 

The danger which we apprehended most, was the superinduc- 
tion of an adynamic state of fever; the consequence of the ab- 
sorption of putrid matter. This state of things did not supervene, 
and we think that to the chloride of soda, in particular, must we 
look as the prophylactic. Never was its power in correcting 
putrid effluvia more signal. To its use, therefore, we are dis- 
posed, in a good degree, to ascribe the safe termination of the 
case of Mrs. D. 



article n. 

Case of Fracture and depression of the fifth Cervical Vertebra, 
with Paralysis. By B. B. Strobel, M. D., Lecturer on 
Anatomy and Surgery, Charleston, S. C. 

Sometime in the month of September, 1833, I received a 

note from Drs. W and D , requesting me to visit a 

patient, and to bring my instruments for trepanning. I imme- 
diately complied with their request. On entering the chamber 
I saw the patient lying on his back in bed, with his shoulders 
elevated. He was a negro, named Billy, of about 40 years of 
age. His pulse was full, soft, and slow. There was an exten- 
sive lacerated wound of the scalp, a large portion being separa- 
ted from the cranium. I introduced my finger into the wound 



198 Fracture, $c. of Cervical Vertebra. [Sept. 

but could discover neither fracture nor depression of the bone. 
Respiration was slow and laborious, being carried on entirely 
by the diaphragm, which caused an alternate rising and sinking 
of the abdomen, as the air was inspired or expired. The pati- 
ent was completely paralysed below the shoulders. Upon 
pricking various parts of the body he experienced no sensation, 
except just above the clavicles, and on the top of the shoulders. 
He complained of no headache, his mind was calm and tranquil, 
he conversed rationally, and said he felt no pain. 

A single glance at the case was sufficient to satisfy me of the 
nature of the injury. I, nevertheless, asked the physicians in at- 
tendance, what operation they proposed, and with what inten- 
tion? They replied, that it was their intention to remove a 
portion of the cranium corresponding to the wound of the scalp, 
for although there was no fracture or depression of the bone, 
they thought the symptoms of compression on the brain, were 
sufficiently great, to justify an operation. I dissented from 
their judgment, and gave it as my opinion, that there was not 
a single symptom present, indicating pressure on the brain, and 
I was well satisfied that the cause of paralysis must depend on 
pressure existing in the course of the spine. 

In order to bring them to the same conclusions as myself, I 
first requested the patient to give us a history of the accident. 
He stated that u he was a seaman on board of a schooner, and 
that his vessel had been employed in getting up an iron chain- 
cable, with an anchor attached to it. To accomplish this, two 
blocks and a tackle were used — being attached on the one hand 
to the mast head, whilst on the other, they were connected with 
the chain-cable. Six or eight men were * bousing' at the fall, 
whilst Billy took in the slack, around a elect, near the deck. — 
This required him to stoop low, with his head bent down tow- 
ards his breast. A considerable quantity of chain had been 
hoisted in, and by the approximation of the blocks towards the 
fixed point, elevated nearly to the mast head, when suddenly 
the strap of the block gave way, and the blocks, tackle and 
chain descended with great violence. The patient received the 
block on his head, whilst (I presume) a portion of the chain 
struck him on the back of the neck. He further stated, that as 
soon as struck, he instantly fell, and although he never lost his 
recollection, was immediately deprived of all sensation, and 
power of motion in4)is Jegs and arms." 



1836«] Fnrcturc, c)c. of Cervical Yvrlrhra. 199 

I next proposed an examination of the spine. The shoulders 
of the patient were carefully raised up, and I passed my finger 
down the spinal column. On reaching the spinous process of 
the fifth cervical vertebra, I discovered an evident depression, 
the slightest pressure at this point induced the patient to com- 
plain. 

The Physicians in attendance were soon convinced of their 
error of judgment, and satisfied that no good would result from 
the operation of trepanning. Indeed, there appears to me to 
be but little difficulty, in distinguishing between pressure on the 
brain and spinal marrow. Independently of the symptoms 
which indicate an interruption of the cerebral functions, we 
rarely have paralysis of both sides of the body, occurring from 
pressure on the brain. Were it possible for pressure to exist 
on the brain to such an extent, as to paralyze the whole body 
below the shoulders, death would instantly ensue, as well from 
the interruption of the cerebral, as a cessation of the vital func- 
tions. 

What should be done under these circumstances, was the 
next consideration ? The patient evidently could not live ma- 
ny hours in his present condition. The prospect of relief from 
a surgical operation, was hopeless, and the best surgeons are of 
opinion, that any interference of the operator under these cir- 
cumstances, would be useless and hurtful. I advised the appli- 
cation of fifty leeches along the spine, and a stimulating injec- 
tion. I again saw the patient after the expiration of a few 
hours. The injection had passed involuntarily, and the bladder 
having lost its contractile power, was distended with water. I 
therefore introduced the catheter and drew it off. He was 
insensible to the introduction of the Catheter, as well as to the 
administration of the injection. There was no erection of the 
penis, which according to most authors, usually takes place, 
in such cases as the present. 

I saw the patient early on the next morning. He manifested 
not the slightest symptoms of returning sensation — was incapable 
of moving his limbs, but perfectly rational. His pulse was 
slow and languid. The injection had passed involuntarily du- 
ring the night — it was repeated. Some thirst — for the allay- 
ment of which, he was directed to take cold water in small 
quantities. The bladder had again become distended with wa- 



200 Fracture, $c. of Cervical Vertebra. [Sept. 

tcr, and was evacuated. A blister about two inches wide was 
applied along the whole course of the spine. The condition of 
the patient remained unaltered to the time of his death, which 
occurred in about 48 hours after the accident. 

It is worthy of remark, that this patient enjoyed the full, and 
uninterrupted possession of his mental faculties, and conversed 
rationally, until ivithin a few moments of Ms dissolution. The 
whole of the body below the point of injury, was to all intents 
and purposes dead, for forty eight hours, and yet the mind con- 
tinued to think and reason, a most conclusive proof, that the 
brain is the material organ, through which its manifestations 
are developed. 

Post Mortem Examination. 
There was no appearance of inflammation about the brain, 
but some venous congestion. The lungs were in a normal 
condition, but of a darker colour than natural from congestion. 
The other pectoral organs exhibited nothing remarkable. The 
intestines as well as the liver were sound. The internal surface 
of the stomach, was slightly tinged with a blush of inflamma- 
tion, and contained portions of undigested food, which had been 
eaten before the accident, evidencing a partial, if not a total 
cessation of the digestive function. In examining the spine, I 
discovered that the fifth cervical vertebra, was fractured at the 
point where the roots of the spinous and transverse processes 
unite to form the vertebral lamina?. The posterior portion of 
the bone being forced into the vertebral canal, — the upper por- 
tion of the fragment had been driven in with such force, that it 
not only ruptured the ligamentum dentatum, but had made its 
way through the proper membrane of the spinal marrow, into 
its substance. There was a considerable effusion of blood, evi- 
dences of great inflammation in the spinal marrow. 



1830.] The Secretions. 201 



ARTICLE III. 

Essay on the Secretions. By R. D. Moore, M. D. of Athens, 
Georgia. 

I am perfectly aware of the numerous difficulties with which 
I have to contend, in arranging and placing before the profes- 
sion the doctrines intended to be inculcated in the progress of 
the present essay. Situated as I am, in the interior of Georgia, 
deprived of access to extensive libraries, I may present ma- 
ny thoughts which are old, yet they strike my mind as true, and 
as such, I offer them, and hope that if they are not true, some 
one possessed of more advantages and a better intellect, will 
undertake the subject, and correct the impressions that now 
prevail. 

The science of medicine has within the last half century, im- 
proved almost beyond the hopes of its most devoted followers, 
and is still marching onwards, unfolding the mysteries that en- 
circle many subjects of deep and lasting importance to the 
practice of medicine. In physiology, by thorough and diligent 
investigation, we have advanced on many subjects, almost to the 
verge of perfection, yet the field is wide open, and much re- 
mains to be done ; old theories must give way and new ones 
spring up, and be perfected under more auspicious circumstances. 

We generally imagine that the exposure of certain organs, 
during the performance of their functions, will completely de- 
monstrate their secret and mysterious nature ; but conclusions 
derived from this developement, must necessarily be exceeding- 
ly erroneous, because, many of these functions are greatly mo- 
dified, nay, some entirely changed by the exposure which is 
necessary for inspecting them ; yet, I admit that much has been 
done in this way, that may lead us a considerable distance on 
the path to improvement. 

Amongst the most intricate and obscure of all the animal 
functions, we find secretions perhaps the most obscure. I have 
looked with diligence into the various works on the subject, but 
have not been satisfied ; nor am I with my own observations, 
although they have a strong tendency to convince me that the 
ideas thrown out in the following pages arc founded in truth, and 
26 



202 The Secretions. [Sept. 

probably are the true interpretations, though imperfect ones, of 
the functions, yet I must acknowledge the diffidence with which 
I offer them for the consideration of the faculty. To simplify 
the subject as much as possible, I shall assert that all secretions 
in the human body are the result of mechanical structure, or or- 
ganization of the blood and vessels, aided by chemical affinities, 
and the whole the result of the circulation. 

It has been proven beyond a reasonable doubt, that the mass 
of blood is composed of integrant particles, which particles pos- 
sess a globular form, and float in an aqueous fluid. Richerand 
says, "its colour is owing to a prodigious number of globular 
molecules, which move and float in an aqueous fluid ;" and again, 
the same author says, " they are solid and formed by a nucleus 
or red point, covered by a membranous vesicle, which appears 
to be readily formed or destroyed." Dr. Thompson, of Edin- 
burgh, in his experiments instituted for the purpose of illustra- 
ting the phenomena of inflammation, came to the same conclu- 
sions. He says, that he distinctly saw the circulation going on 
in the web of a frog's foot, which was sufficiently transparent to 
allow him to observe the globules follow in quick succession one 
another, through the capillary vessels. He speaks of these glo- 
bules every where, and is firmly convinced of their existence, 
and so may any member of the profession, if he will procure a 
microscope and test the fact by ocular demonstration. Nothing 
more need be said of the spherical shape of these particles of 
blood, for it is the necessary result from the nature of their con- 
stituent parts. There can be little doubt, that the red point is 
nothing more than a fluid embraced and compressed on all sides 
by a membranoid substance, which enveloping it in this manner 
will give it the globular form. 

When blood is drawn from the body we first observe the phe- 
nomenon of coagulation which will take place under various cir- 
cumstances of heat, cold, exposure to and exclusion from the 
air. We next witness a still more remarkable fact, its separa- 
tion into serum, coagulum and fibrin. This has been attributed 
to various causes, such as gravity, and particularly to a vital 
movement of the denser particles by which the scrum is separa- 
ted, but I am convinced it depends on a cause utterly distinct 
from this vital movement among the particles; on the contrary 
it is the consequence of the destruction of a degree of organiza- 



183G.] The Secretions. 203 

tion which the blood possesses, and which will take place more 
or less suddenly in proportion as that organization is affected 
by the condition of the whole system. Now if these molecules 
or particles do exist in the mass of blood, the enquiry arises, for 
what purpose are they destined in the animal economy, if they 
are to retain their globular form ? It is clear, since the parti- 
cles of blood have a form and definite size, they are to a certain 
degree divisible, and that their destination is to repair the rava- 
ges committed on the system, by the daily and momentary de- 
monstrations which take place in the phenomena of life. 

All the solids are evidently derived from the fluids, and even 
the smallest vessels which contain them, are supplied by the 
destruction and consumption of the particles of the blood ; they 
must, therefore, lose their globular form, before they can by the 
process of nutrition become component parts of bone, tendon, 
muscle or nerve: this I conceive to be clear and needs no further 
investigation. The second enquiry then arises, how is this 
change effected, and where? It is altogether unnecessary to 
enter into a minute anatomical account of the circulating sj^stem, 
but simply to mention, that its centre, the heart, is composed of 
four cavities, each being well supplied with strong muscular fi- 
bres, which by their contraction force the blood into the arteries 
which is thus forwarded to every part of the system,and is brought 
back again by the veins ; but not until it has passed through an 
intermediate set of vessels called capillaries, partaking both of the 
nature of arteries and veins. They are of various sizes, from 
those whose calibers can be measured, to those which are invi- 
sible to the eye ; moreover, many cannot be seen, even with the 
a ; d of powerful glasses. No anatomist has ever demonstrated 
to the sight, that vessels circulating a fluid, exist in tendons, liga- 
ments, or cartilages in the healthy state, but if either be cut 
off from a communication with the heart, death is the inevitable 
consequence at a period more or less remote. Who has not 
seen an inflamed tendon freely injected with red blood and 
consequently when rent, unite by granulation, similar to that 
which we observed in granulating muscle ; an incontroverti- 
ble evidence, not only of the existence of those vessels, but 
also of the extreme minuteness of their caliber, showing con- 
clusively, that the globular form must change, and also where 
this change takes place. No one will contend, because these 



204 The Secretions. [Sept. 

tendons, cartilages and ligaments arc white, that they are nou- 
rished by a matter only slightly annualized, but rather that the 
red blood does not communicate its colour, yet they possess a 
degree of vitality far superior to that of chyle, which has been 
only under the influence of vital action for a few minutes. I do 
not wish to be understood, that the whole mass of blood imme- 
diately after it leaves the heart, is possessed of the same degree 
of elaboration, for if so, how would it be possible satisfactorily 
to account for the difference of excitability of organs ; as for in- 
stance, between the cartilages and the retina — the same material 
will not produce these organs indiscriminately. The blood 
which we see in an inflamed eye, is the result of the increased 
capacity of the capillaries, not effusion, for if so, it could not be 
removed only by absorption, which is not the fact. The same 
is true with regard to some congestive diseases of the lungs and 
the mucous tissues generally. If this is conceded, it follows as 
a necessary consequence, that the accretory process is carried 
on by a deposition from a highly vitalized fluid — that when these 
molecules reach these capillary vessels in a healthy body, they 
must either be capable of passing through unchanged, or they 
must suffer a diminution of their capacity ; they cannot remain 
in the vessels and be stationary, neither can they recede, the con- 
stantly advancing column behind preventing a retrograde motion. 
A change therefore must take place, and we arc told by some 
authors, that these molecules or globules can be seen changing 
their diameters when compressed by the vital action of the ca- 
pillaries, and become more or less elliptical, till finally the encir- 
cling membrane gives way, allowing the contained particles to 
be exposed to the action of the glands, or in other words to en- 
ter in the composition of muscle, tendon, bone, &c. and the 
parts unfit for such purposes to be excluded. I do not believe that 
all the molecules arc thus broken in every revolution through 
the arterovenous circle; on the contrary, many return to the heart 
in the same form as when they left it, and it is very probable 
that these molecules do not suffer this revolution until they have 
gone through this circle several times, and it is presumable 
that sanguification is not entirely perfect until then. It is very 
unlikely that a fluid taken up but a few minutes before from the 
various masses which arc found in the stomach and towels, 
should after so slight a degree of elaboration in the lymphatic 



1830.] The Secretions. 205 

glands, be immediately constituted blood, fit to repair the waste 
which is the consequence of every exertion. Where shall we 
lay the distinction between blood and chyle, if this be the fact ? 
We are told that out of the subclavian vein it is chyle, and can 
it become blood simply by mingling with the blood in this vein ? 
I imagine that no one will contend that it is, but that the change 
is effected in the heart, and for this purpose is the peculiar ar- 
rangement of muscular cords in the auricles and ventricles, and 
not for their contraction, because this can be, and is, effected with- 
out this peculiar arrangement. My ideas on this subject received 
considerable corroboration from the fact, that colouring matter 
is not detected in the bones of animals until they have been fed 
for some days, but is immediately detected in the glandular se- 
cretions, proving almost conclusively the fact, that these parti- 
cles do go several times through the circulation, before they 
are deposited. 

The observations of Mr. Cruickshank strengthen this con- 
clusion ; he says, that the absorbent vessels arising from arte- 
ries and veins, never take up blood unless it be the result of 
some violence. What then is the duty of the absorbents ? — 
Certainly to effect a change upon the unperfected fibrin, which 
from its importance in the animal economy, cannot be so sud- 
denly formed as is usually imagined. The existence of this fi- 
brin in the blood does not depend upon any chemical act, that is, 
it is not united to either serum or colouring matter, for simply 
by agitation it will remain with either, and may, by violent agi- 
tation, be separated from both, and can be washed white. Nor 
is the fibrin diffused loosely through the blood, but on the con- 
trary exists in the mass as the enveloping membrane, giving to 
the globules their form. The third enquiry now arises : what 
is the result of the change of this form ? We have shown that 
by the contraction of the heart, and aid of the arterial sys- 
tem, the blood is forced into every part of the body through the 
capillary vessels ; some portion of the general mass to be taken 
up by the absorbents, to undergo new elaborations ; some to conti- 
nue the round of the circulation through the larger capillaries 
into the veins and thence to the heart ; some to be forced to the 
surface to be thrown off by means of the cutaneous exhalants ; 
some to the mucous surface of the intestinal canal ; some to the 
various cavities of the body, &c. &c, these being the excre- 



20G The Secretions. [Sept. 

mentitious parts of the blood, which from their superabundance, 
or their having been rejected, are deemed unfit for the perform- 
ance of any useful functions, and when thrown off, serve either 
by their evaporation to diminish the temperature, or to lubricate 
parts requiring lubrication, and finally the perfected blood yields 
over to the body its component parts to form bone, tendon and 
muscle with its appendages. 

All these different arrangements and the results of their action 
on the blood we know, but the precise manner in which it 
takes place, cannot in the present stage of the science be satis- 
factorily accounted for. I disclaim any belief in transudation 
through inorganized parts as a healthy function, and am also 
convinced that the mechanical influence which prevailed some 
time since, is equally incorrect, in as much as chemical affini- 
ties have to do in the act of secretion, and the system is amply 
provided with the apparatus necessary for its action. 

Having now gone through the observations intended to be 
made on this subject, I conclude by stating in distinct proposi- 
tions, the deductions which may be drawn from them. 

1st. That the globular shape is essential for perfect blood. 

2d. Before these globules can be subjected to the assimilat- 
ing process, they must be broken. 

3d. This change is effected by the vital action of the capil- 
laries. 

4th. Secretion is a process established by certain arrange- 
ments of glands, to throw off from the body those substances 
which are unfit for nutrition, or superfluous, or which are to be 
used in other parts, and whose usefulness can only be acquired 
by this process. 

Whether these deductions be admitted or not, I can only say 
they are founded on observation, and deduced from facts, 
which made a strong impression on my mind. I repeat it again, 
if they are not true, I will be much obliged to any one, who will 
demonstrate their incorrectness. 



1836.] Remarkable Osteo-sarcomatous Tumour. 207 



ARTICLE IV. 

Remarkable Ostco-sarcomatous Tumour in the person of II. A. 
Franklin, late of Columbia County, Ga. with Remarks and 
Notes. By George K. Holloway, M. D., of Warrenton, 
Georgia. 

Dr. Holloway has kindly presented us with a minutely de- 
tailed history of the above named case, in the w T ords of the un- 
fortunate subject of it, Mr. Franklin himself; which being as 
well drawn up as could be expected of an unprofessional man, 
we shall give it entire. 

Description of a singular Case of affliction. 

I, Henry Augustus Franklin, was born on the 9th of Febru- 
ary, 1800, and from my childhood up to manhood, enjoyed un- 
interrupted health ; and being blest with a good constitution, 
and having for the last 4 or 5 years been singularly afflicted, 
am desirous of giving in my own language, a short history of 
my case ; to wit: 

In October, 1831, I was attacked with intermittent fever, 
which continued about two months. After the fever had appa- 
rently left me, I was troubled with a great enlargement of the 
spleen until the following February. During this time I was 
attacked with severe pain in the right hip, which I thought scia- 
tic or rheumatic, and treated it accordingly, without finding any 
relief. In January, 1832, my health somewhat improved ; I 
began to work, and continued at work until May ; my health 
continued to improve, but the pain still continued. In feeling 
my spleen often, during this time, which I discovered was re- 
ducing very fast ; about the last of February, of the same year, 
I felt something of a hard substance of rough bumpy shape in 
my right groin, which was firmly seated in the cavity of my 
right hip. During the time from February on some months I 
felt that the action of my right leg had failed, particularly when 
lifting any thing; running or going up steps, &c. # 

* About this time Mr. Franklin suffered very much from carbuncles, 
which were very numerous on the whole of the right or diseased side, and 
particularly so in the vicinity of the tumour, and some of them were quite 
large. 



208 Remarkable Osteo-sarcomatous Tumour. [Sept. 

Feeling much alarmed, I made early application to Dr. David 
Cooper, of Wrightsborough, who after examining the case, sta- 
ted that he had no knowledge of it, and recommend me to go 
and see Dr. Antony, of Augusta, whom I visited in March of 
the year 1832. Dr. Antony after some reflection recommended 
the use of Iodine Ointment, which I used constantly for two 
months without receiving any benefit. Several of my friends 
believing it to be rheumatic pains, recommended me to blister 
plasters, which I applied, and kept it sore and running for seve- 
ral w T eeks, which instead of benefiting, injured me very much. 
The pain continued intensely, and my friends yet believing it 
rheumatism, I was advised to visit the mineral springs. I went 
to the Indian Springs and bathed and used the water for more 
than a week, and receiving no benefit, I went to the Warm 
Spring,* in Meriwether County, where I spent eight or nine 
days, bathed frequently, but found no relief. I returned home 
much worse than I left it, owing to the fatigue, hard lying, &c. 
the pain in the hip joint still increasing ; so much so, that I could 
not sleep. When at the Warm Spring, not being far from 
Columbus, I went there and saw Dr. Cooper and Dr. Nicholas 
Childers, a man of much skill in his profession, who examined 
me, and was somewhat of opinion that an operation would prove 
successful, if the warm season had passed. The pain still in- 
creasing and the thigh shrinking a little. 

On my way home, I called on Dr. White, of Milledgeville, 
who very politely invited Drs. Fort, Boykin and Brown, to as- 
sociate with him in an examination of the tumour, which had 
very much enlarged by this time. After a careful examination 
by them, Dr. White inclined to the opinion of cutting the tumour 
out, and was of the opinion that it might be done with safety. 
The others differing with Dr. White, and thinking it impractica- 
ble, he would not undertake it without their assistance and con- 
currence. From this time on to November, I suffered the most 
excruciating pain, my leg gradually shrinking and the tumour 
enlarging, yet I was enabled to walk without the aid of cane or 
crutches, and my general health was good. About the last of 
November, I determined to go to Augusta, as the Medical Fa- 
culty were in session, to sec if I could get any thing done to 

* The Warm Springs in Meriwether County, Ca. arc said to be useful 
in .some cutaneous di 



ISM.] Remarkable Osteo-sarcomatous Tumour. 200 

relieve my pain, which was now almost insupportable. On my 
way to Augusta, I called on Col. Z. Williams, and his son Dr. 
R. Williams requested, (if the board of physicians should not 
do any thing for me) to call as I returned and spend sometime 
with him. When I arrived at Augusta, I was examined by 
many of the medical men, who did not advise any course par- 
ticularly for me to pursue. 

I came to Dr. Williams very much disheartened, and suffer- 
ing so much, that I did not think I should long survive. 

Dr. Williams put me under a strict regimen or diet, restrict- 
ing me in my food, and giving me gentle purgatives, until he 
reduced me very low. Towards the latter part of January, 
1833, I had lost the use of my leg, which was probably occa- 
sioned by my lying in one position such a length of time ; the 
tumour still increasing, yet I believe the pain was not so severe. 
In February, I returned home, and began eating more, and my 
leg began to gain strength, which was the case from January to 
September. I did not restrict myself so much in my diet, 
and was able during that period to walk about the neighbour- 
hood, nevertheless, I was never a moment free from pain, and 
it was very painful for me to sit any length of time. The pain 
w T as all the time in the right hip joint. 

Believing from the first appearance of the tumour that no- 
thing short of an operation would relieve me; and having during 
the summer become acquainted with Dr. Holloway, he w r as of 
the opinion that it could be taken from me successfully, by the 
skilful surgeons of the north. Dr. Holloway immediately 
wrote to Drs. McClellan and Hewson of Philadelphia, stating 
the progress of the case, who promptly answered him that from 
what he had stated, they believed it could be taken from me 
successfully. He gave me letters of introduction to them, and 
on the 11th of September, 1833, 1 started for New- York. 

At Augusta, my friend Dr. Antony visited me, and advised 
me as I had started, and as my mind was made up to get all 
the medical skill in my reach, to go on, and accordingly gave 
me a letter of introduction to Dr. Dickson of Charleston, also 
one to Dr. Mott of New- York. At Charleston I was visited 
by Dr. Dickson and several other intelligent medical men, who 
examined my case strictly, and gave as their opinion, that no 
surgeon having any regard for his professional character would 
27 



210 Remarkable Osteo-sarcomatous Tumour. [Sept 

operate on me. I remained in Charleston 7 or 8 days, during 
part of which time I was very unwell ; the tumour continually 
increasing in size, but never painful. After I got over my sea- 
sickness, I began to improve very fast in my general health, 
and when I reached New-York, my strength was much greater 
than when I left home, and the pain in my hip not so excrucia- 
ting as before. 

At New- York, Dr. Valentine Mott examined me very atten- 
tively and was clearly of opinion, that an operation would pro- 
duce certain death. His words were, " I would as soon cut 
your throat to save your life, as to cut that tumour from you 
with the expectation of saving you." At Philadelphia, Drs. 
McClellan, Hewson and Patterson, examined my situation, and 
all of them, except Dr. McClellan, were opposed to having it 
cut from me. He stated, that he believed he could extract or 
take it away without endangering my life ; but was of opinion 
if taken away it would return again, that it was a disease of the 
blood. I did not see the venerable Dr. Physick, although I had 
a letter of introduction to him, and my brother called twice at 
his residence, yet he was so closely engaged in an important 
case from Missouri, that he never saw me. The pain in my 
hip still continuing and the tumour enlarging. Dr. Mott wrote 
to Dr. Anton?/ on the subject, in answer to his letter, which had 
recommended the use of Iodine. From Philadelphia I went to 
Norfolk via Baltimore, and was there visited by several medi- 
cal men of the borough, who looked upon my case as an unpa- 
ralleled one in the history of diseases.* Dr. Mott was the only 
one who stated that an almost similar case had fallen under his 
observation. From Norfolk we returned to Baltimore, and 
from thence took passage in the brig Gen. Marion, to Charles- 
ton, where I arrived with my health much improved, and In 
three days after, reached home about the 20th of October. Du- 
ring the fall and winter I enjoyed very good health, although 



* Wc think wc have seen a case somewhat similar in its nature, it was 
a tnmotU that imparted to the touch the same feeling. By the attending 
physician it was thought to be an abscess, it was accordingly punctured se- 
veral times and discharged a thin white healthy matter or pus. This tu- 
mour was also situated low down in the right iliac region, and extended near- 
ly across the lower pari of the abdomen, but was not near so large as Mr. 
{franklin's. The subject, was a female, it eventually proved fatal. In this 
ease no post mortem examination was made. — G. K. II. 



1830.] Rc}?iarkable Ostco-sarcomalous Tumour. 211 

the pain continued very severe and the tumour continued to en- 
large. 

About twelve months previous to this time, I suffered much 
pain in my right leg from my hip to my ancle at intervals — so 
severe, that it seemed as if some person had hold of the nerves, 
jerking them. 

My health continued very good until the 1st of September, 
during which time I was able to walk about the neighbourhood, 
by resting frequently ; my thigh and leg having shrunk to a 
mere skeleton of a limb. About the 1st of September, 1834, 1 
was taken with an ague, and fever succeeded it, and both conti- 
nued on and off for two weeks ; at this time my thigh commenc- 
ed enlarging at my hip, and my ancle also became swelled, 
which would appear and then recede for several days, until- the 
swelling passed over the whole limb, and has remained so ever 
since. In the latter part of November, I had a severe ague, 
and when the fever came on, from my ancle bone to my arm pit 
on the right side appeared as if mortification would soon follow. 
I called in Dr. McCraven during this time, who succeeded in 
stopping the fever, and by poulticing the part inflamed, it at 
length recovered its healthy appearance. All this time the pain 
was intense and the place still enlarging. During the spring 
and summer of '35, I became able to go about with my crutch- 
es ; at this time the course of the tumour w r as such as to throw 
my hip entirely out of joint, which it effected slowly, but 
attended with indescribable pain.* This was very apparent 
from the twisted position in which my foot and ancle w T ere 
placed ; and during the summer Dr. Williams visited me, and 
had no hesitancy in declaring that the hip was out of joint. I 
continued pretty much in this situation, suffering extreme pain, 
until about the 1st of ^November, when I was taken by another 
ague which lasted for several hours and left me prostrate. Soon 
after this, large blisters formed on my leg, and run much water, 
then became sore and appeared like the worst kind of ulcers. 
They however soon dried up. In the course of three weeks I 
had another ague which carried me back to my former pros- 
trate condition ; similar blisters formed and similar sores upon 

* The head of the femur was to all appearance completely luxated ; and 
in the fall of 1835, and up to the time of dissolution, the right limb was ge- 
ncraJly several degrees colder than the left.— G. K. H. 



212 Remarkable Osteo-sarcomatous Tumour. [Sept 

my leg, which in the course of two or three weeks would dry 
up. In January, 1836, I was taken about one o'clock with an 
ague, which continued on me till after three. From that time 
to the present, I have been helpless ; my leg and thigh large, 
apparently ready to burst, blisters formed and running sores 
came in their places. The tumour has been constantly grow- 
ing, and a few days ago some blisters formed near the rough 
points of the tumour, and on pricking them with the point 
of a needle, matter issued from them ; and now a hole suffi- 
ciently large to take in the end of a walking cane has opened, 
and large quantities of matter run from the place daily and 
hourly, of a light cream color and not offensive to the smell. — 
For the last month or two the pain in my hip, knee and ancle 
has not been as severe as it was previously. During the whole 
of my severe affliction which has been upwards of four years, a 
great many prescriptions have been given, and I have tortured 
myself with many applications without receiving any benefit. 
My only medicine, since I returned from New- York, in 1833, 
has been opium and Laudanum, which I have used unsparingly, 
and it is all that has in the least mitigated my sufferings : there- 
fore, I would recommend it to -all who are similarly situated. 

Dr. Holloway has also furnished us with an account of the 
post mortem and autopsic appearances, together with some ad- 
ditional facts appertaining to the case ; amongst which is a re- 
ference to a slight injury of the anterior superior spinous process 
of the ilium of the right side, previous to the appearance of the 
disease, which he supposes to be, and we think very correctly, 
the excitins: cause of this dreadful case. The rest of the addi- 
tional facts will be found in the notes of Dr. H. appended to Mr 
Franklin's narrative. 

Mr. Franklin died on the 5th of March last. The following 
is Dr. Holloway's account of the post mortem and autopsic ap- 
pearances. 

On the morning of the Gth of March, being eighteen hours 
after death, we proceeded to the autopsic, in the presence of 
Dr. Henry Lockhart of Warrcnton, Dr. Edward Jones of 
Wrightsboro,' Mr. S. Ircy, a medical student, and several res- 
pectable gentlemen. 

External appearance. The countenance natural, with the 
exception of being very much shrunk and wasted by disease. 



1836.] Remarkable Osteo- sarcomatous Tumour. 213 

The body appeared as that of a person labouring under dropsy, 
only very much larger. The right lower extremity was enor- 
mously swollen-the foot elephantiastic-the left limb was a perfect 
skeleton in comparison — the arms literally skin and bones. — 
The stench arising from the body was peculiar in kind, and ex- 
tremely offensive ; for the correction of which we washed the 
body, and injected the cavity of the tumour through the ulcera- 
ted opening with a disinfecting liquor — concentrated solution of 
chloride of soda. The integuments for 12 inches around the 
opening into the tumour, were sphacelated. Such were the ex- 
ternal appearances. 

Autopsic. — A crucial, incision was made from the scrobiculus 
cordis, to the symphysis pubis ; and from the anterior superior 
spinous process of one side, to that of the other. When the 
flaps thus made were turned aside, the tumour only was brought 
into view ; the rest of the abdominal contents being completely 
hid, except the omentum, which was very much shrunk — very 
small — not more than one quarter of the usual size, and appear- 
ed very much like that of a person who had for a long time la- 
boured under chronic dysentery or some other chronic inflam- 
matory affection of the abdominal viscera. Upon dipping down 
and bringing into view the stomach and small intestines, they 
presented an anomalous appearance, evidently shewing the ra- 
vages of disease. The spleen was more than twice its normal 
size — the kidneys of more than three times their usual size — the 
pancreas very nearly obliterated — the liver very much enlar- 
ged and deeply tinged with bile — the gall bladder more than 
five times its ordinary diameter, and full of bile — the blood ves- 
sels generally, but more especially the larger, in a state of high 
inflammation. Such were the phenomena presented by the 
viscera of the abdomen. 

The thorax was next examined : the lungs healthy — the heart 
very much enlarged — the blood vessels very similar in appear- 
ance to those in the abdominal cavity — the villous or mucous 
coat of the bronchia not injected. 

The tumour completely filled the whole of the abdominal ca- 
vity, except a very small space in the left hypochondrium. — 
It appeared to have originated and proceeded from the 
anterior superior spinous process of the ilium of the right 
side, and to be closely and firmly attached to the whole of the 



214 



Remarkable Osteo-sarcomatous Tumour. 



[Sept 



inner concave surface of that bone, dipping down and covering 
the whole internal surface of the pubis, part of the ischium, almost 
the whole of the sacrum, and adhering on the right side to the 
whole of the lumbar vertebrae and from the centre of the dia" 
phragm near the heart, protruding through the abdominal ring 
below Poupart's ligament, and under the fascia lata of the thigh 
to within a few inches of the knee. 

Great care was not taken in dessecting out the tumour, con- 
sequently all that part below Poupart's ligament was left un- 
touched in the thigh, and in some places where it was dissected 
it was certainly not less than an inch or two thick. 

The tumour, if we may be allowed the expression, was what 
might be denominated a fatly tumour, interspersed with ossious 
granulations of the size of small squirrel shot, some larger. In 
fact when cut into it had very much the appearance and firmness 
of the fat part of a brisket of beef. 

The following are the dimensions and weight of the tumour, 
after excision, and the comparative size of the two limbs. 



Transverse diameter of the Tumour, - 



18} inches. 



Longitudinal " " 


a 


24} « 


Diagonal " " 


it 


one way, 22} " 


u u u it 


St 


the other way, 25} " 


Circumference, - 


- 


61} " 


Weight of the Tumour, 


- 


26} lbs. 



Left or sound Limb. 
Around lar^e trochanter 18 In. 



Middle of the thigh, 
Above the knee, - 
Below the knee, - 
Calf of the leg, - 
The instep, - - 
Middle of foot, - 



12 " 

10} " 

11 " 

9£" 

13}" 

10}" 



Right or diseased Limb. 
Around large trochanter 29} In. 
Middle of the thigh, - 25£ " 
Above the knee, - - 21 1 " 
Below the knee, - - 19 " 
Calf of the leg, - - 19} " 
Above the ancle, - - 13} " 

Instep, 16J " 

Middle of the foot, - 13 " 



The tumour, if neatly dissected out, would have weighed at 
least from 30 to 35 pounds.* 



* By the kind attention of Dr. Jones, the tumour, an enormous wet 
preparation, which we understand Mr. Franklin requested should be pre- 
sented to the Medical College of Georgia, has been forwarded, and may now 
be seen in the valuable and extensive Museum of that promising institution. 
— Editors. 



1836.1 



Thermometrical Observations. 



215 



ARTICLE V. 

Thermometrical Observations for April, 1836, kept in Cass 
County, Geo. By H. V. M. Miller, M. D. 

CassviHe, Cass County, July 16th, 1836. 

Gentlemen, — Believing that some of your readers may wish 
to compare the range of the Thermometer in this portion of the 
state, (which is considerably resorted to by persons from the 
lower counties, for the recovery of their health,) with that fur- 
nished you from Burke county, and published in your second 
number ; I send you the following table for the month of April 
of this year. 

The thermometer was in a shaded situation during the time, 
and the temperature noted as will be seen in the table, at the 
hours of 10 A. M. and of 3 P.M. 

Although not so complete as that of Professor Cotting, yet I 
hope it may afford some satisfaction so far as it goes to show 
the difference of mean heat between the two places, and the 
more considerable and sudden variations in the temperature of 
the atmospeere in this county. 





t— 1 








t— i 








o 


CO 






© 


CO 






o 


o 






o 


i_. o 




« 


>o- 


*0n 




« 


>n 


^n 




to 

*-< 


^ 
2 « 


*% 




p 
<< 


*% 


>% 






!^*r 


r»>r 






FK- 


***■ 





REMARKS. 



1 
2 

a 

4 

5 

a 

? 

8 
9 

10 

11 

12 
13 

14 
15 



48 
66 
65 
52 
46 
50 
51 
58 
60 
62 
67 
67 
59 
52 
52 



65 
73 

72 
53 
50 
59 
62 
63 
70 
62 
77 
78 
64 
62 
50 



Cloudy. 



Cloudy. 
Rainy. 



16 


49 


63 




17 


50 


62 




18 


62 


70 




19 


64 


64 


Rainy. 


20 


68 


76 




21 


61 


GQ 


Cloudy. 


22 


63 


74 




23 


60 


68 




24 


63 


78 




25 


71 


78 




26 


70 


78 




27 


64 


70 


Cloudy. 


28 


60 


60 




29 


62 


74 




30 


65 


70 


Rainy. 



By this it will be 
seen, that the average 
temperature in Burke, 
at sunrise, is about e- 
qual to the average 
temperature here, at 
10 o'clock, A. M. and 
that the average at 12 
o'clock in Burke, con- 
siderably exceeds the 
average here at 3 P. 
M. which is about the 
hottest hour of the day. 



21 G Medical Education. [Sept. 



ARTICLE VI. 



Medical Education. By Joseph A. Eve, M. D. Professor of 
Therapeutics and Materia Medica, in the Medical College of 
Georgia. 

The present defectiveness of medical instruction in the United 
States is acknowledged and deplored, by the most enlightened 
and distinguished physicians of our country. But so long have 
these defects and abuses existed, so sacred have they become by 
age and custom, that it is believed innovation would be attended 
with difficulty, if not danger, and that the necessary and much 
desired reform must be the result of a gradual change of public 
sentiment, the conquest of light and principle, the work of time. 

No one can be more zealous for a radical reformation in our 
Colleges than an eminent professor in the University of Phila- 
delphia ; he recommends the creation of additional professor- 
ships and the introduction of other newly originated branches of 
science into a course of medical education, and observes farther 
that " a prolongation of the term is essential ;" but he says it is 
not for the present generation to undertake this reform. Whilst 
we admire the, zeal which Professor Jackson displays on the 
subject of reformation, we are compelled to differ from him al- 
together in the sentiment, that it is not to be attempted at pre- 
sent. We hold that the proper time for correcting abuses is 
as soon as they have been perceived and acknowledged, 
by those best qualified to judge respecting them. How long 
would this distinguished professor delay this reformation? — 
How long would he defer a consummation so devoutly to be 
wished ? Would he wait until these evils become more enor- 
mous and flagrant than they are? To what more auspicious 
period would he postpone the enterprise ? What generation 
more meet than this — what school more able than that to which 
he is attached, to commence this reform ? 

The spirit of the times calls aloud for reformation — the rapid 
march of intellect — the numerous important discoveries and 
improvements in the arts and sciences require it now, and ere 
long the voice of a more enlightened people will demand it. 



1838.] Medical Education. 217 

But shall our colleges wait until an indignant people, pro- 
voked by the ignorance and incompetence of their graduates, 
demand it ? 

Is not the wide spread of empiricism in our country indubita- 
ble proof of the degradation of the profession, and of the necessi- 
ty for improvement ? Where should be the origin and whence 
the emanation of this reform ? — in the colleges themselves? or 
among the people ? With whom commenced the Reforma- 
tion ? the priesthood ? or the people ? And the temperance re- 
formation — the glory of our age and nation — with whom did 
it originate ? Did the temperate-, the moral and the pious, with 
folded arms and unavailing lamentations, bewail the awful ra- 
vages of Intemperance, and wait for his victims to commence 
the reform, or defer the glorious enterprise for generations yet 
to come? No! It is not thus with the spirit of a Luther or a 
Melancthon. When the light breaks in and the evil stands re- 
vealed, the true reformer, with a noble daring and a heaven- 
kindled flame of holy zeal, that danger cannot damp, and 
nought but death extinguish, asks no further omen, but uncon- 
querably firm, resolves on reformation, or a martyr's grave! — 
For the correction of evils we should certainly look to those 
whose exalted position affords them the best opportunity to 
perceive, and the greatest power to reform them ; and therefore, 
this distinghished professor has not discharged his duty to sci- 
ence and society, in merely " shewing the necessity of a radi- 
cal reform," and waiting for " a rising generation" to under- 
take it. 
1/ Onward ! onward ! to improvement and perfection, is the 
motto and watchword of the present age ! All around is press- 
ing forward. Why then should medical colleges alone be con- 
tent to tread the same antiquated path, and perpetuate the errors 
and defects of darker days? Can the profession of medicine 
ever assume or maintain the elevated position it ought to oc- 
cupy, whilst the courses of collegiate instruction are so imper- 
fect, and degrees conferred on such meagre attainments ? 
\J How limited, how imperfect is the course of instruction in 
the medical schools of our country compared with that of Paris, 
in which the faculty consists of 24 professors and 24 agreges or 
adjuncts, and the period of attendance on lectures requisite to 
render a candidate eligible to a degree, comprises four years. — 
28 



218 Medical Education. [Sept. 

How defective, how small in comparison arc the provisions and 
requisitions of the colleges in the United States? That medical 
schools are on a better footing in France, than in our country, 
or any other on the globe, is chiefly attributable to the greater 
liberality of the French government, in creating and cherishing 
literary and scientific institutions. In the annals of history, no 
government in any age has ever been so munificent in the pro- 
motion of science and literature. The professorships in the 
Parisian schools, are endowed by government, and every pos- 
sible facility, opportunity and advantage afforded for the pro- 
secution of every department of medicine ; but we must not 
attempt in this place to recount all that France has done to 
facilitate the acquisition of knowledge, and advance the me- 
dical sciences to the highest state of perfection. The abuses 
and defects so deeply deprecated and deplored, are not how- 
ever to be charged against our government. Had we the 
industry, zeal and enthusiasm of our Gallic brethren in the cul- 
tivation of science, we would not look to future generations to 
undertake this reform ; nor would government be slow to lend a 
fostering hand ; the acknowledgement of its necessity would 
scarcely precede its accomplishment. 

The principal defect that requires correction is the shortness 
of the term, which in most of our colleges continues only from 
three and a half to four months ; this at best merely allows time 
sufficient for a very elementary and imperfect course, and re- 
quires so many lectures to be delivered each day, that the stu- 
dent, unless previously well prepared, cannot comprehend them, 
and very little time is allowed for reading and reflection, or for 
the prosecution of practical anatomy. 

This which we regard by far the most important and radical 
defect, has been partially but imperfectly corrected by the Me- 
dical College of Georgia, \whose course continues six months; 
fewer lectures, (three, at most four,) are delivered each day, all 
in the forenoon ; the whole afternoon may be devoted to dissec- 
tion and the evenings to reading. The trustees were so im- 
pressed with the imperfection and inefficiency of the plan 
hitherto adopted, that they determined to make this important 
innovation, and the result has proven highly gratifying to them; 
for all who have had an opportunity of testing the comparative 
advantages of both, have uniformly expressed the most decided 



183G.] .. Medical Education. 219 

preference for the prolonged over the shorter course ; indeed, it 
is their general declaration, that a student can derive at least, 
double the benefit from the former that he can from the latter. 
This is certainly correct as respects beginners in the study of me- 
dicine. But the length of the term has deterred and doubtless will 
always deter many from attending the lectures of this college, 
whilst others pursue the old system ; for important and obvious as 
are the advantages of the prolonged term, unfortunately, alas ! for 
the honor of the profession and the good of humanity, too many 
students desire no more-aspire no higher than to obtain a de- 
gree in as short a time, and with as little exertion as possible — 
content to practise the honourable and exalted profession of me- 
dicine, as a mere trade, or at most to attain to an ignoble medi- 
ocrity, scarcely less disgraceful than professed empiricism. — 
Such will always go where they can procure a diploma, the 
object of their highest aspiration, most easily. Such alumni 
can only reflect discredit and disgrace on their alma mater, and 
therefore should not be desired by any college. 

The extension of the term to six months, although a very 
great- improvement upon the shorter course, is still but an ap- 
proximation to the proper duration ; lectures in medical as in 
other colleges, ought to be continued through the whole year, 
with the exception of one or two months' vacation ; the course 
should comprise many more branches than are taught in the 
schools of our country ; and at least four years' attendance 
should be required to render a candidate eligible to the Docto- 
rate. And certain requisitions should be adopted with respect 
to preparatory education. No student should be allowed to 
matriculate, or to be enrolled as an eligible candidate for a de- 
gree who could not stand a creditable examination on the stu- 
dies prescribed. 

So desirous for reformation have the faculty of the Medical 
College of Georgia been, (since the first establishment of this 
institution) that they suggested the idea of calling a convention 
of delegates from all the colleges of the union, to devise some 
general plan, and adopt a system of education, which should be 
uniform throughout the United States ; to accomplish which 
great and desirable object, they addressed the following circular 
to all the respectable medical institutions in this country. 






220 Medical Education. [Sept. 

MEDICAL COLLEGE OF GEORGIA, ) 

May, 1835. \ 

To the Faculty of the Medical College of, <J-c. 

" The Faculty of the Medical College of Georgia, would pre- 
sent to their fellow labourers in the cause of medical science, a 
subject of great importance and of common interest. 

We believe it is a subject of regret universal among the offi- 
cers of our medical colleges, that the terms of admission into 
the profession are so easy ; that young men do now present 
themselves, and with confidence, as candidates for its highest, 
honors, whose want of previous education and of mental disci- 
pline disqualifies them to reap the advantages which may be 
offered at our various institutions ; and that all unprepared as 
such are for discharging the duties of so difficult profession, and 
for contributing to its improvement, custom requires they must 
yet be admitted into its ranks. Although some of our schools 
may be peculiarly exposed to such evils, still we believe they 
are sensibly felt, and will be acknowledged by all. 

Thoroughly convinced that the profession, whose respectabi- 
lity it is alike our duty and inclination to advance, requires that 
the medical colleges of the United States, now, take some deci- 
ded action upon this subject of Medical Education, we beg leave 
respectfully, to solicit your co-operation in effecting a Conven- 
tion of Representatives from the medical colleges, to be held at 
Washington, for the purpose of establishing an uniform system 
of requisitions for the degree of Doctor of Medicine ; of regulat- 
ing the courses of professional study ; the extent of previous 
education ; and counselling generally about the means of ren- 
dering our institutions most successful in diffusing the benefits 
of Medical Education. 

We do not fix upon any time for holding this proposed con- 
vention ; but in our communication to the University of Penn- 
sylvania have proposed May 183G. This will allow ample 
time for making all necessary arrangements and for that deli- 
beration which the importance of the subject demands. We 
would, however, suggest that the -determination of the time, 
the number of delegates from each college, &c. should be 
referred to the Faculty of the University of Pennsylvania, the 
oldest medical school in our country. 



1836."] Medical Education. 221 

Should this suggestion meet your approbation and concur- 
rence, we shall ever rejoice in having contributed to a reforma- 
tion, which, though it may operate peculiarly to the disadvan- 
tage of our own college, will yet promote the interests of the 
common cause of medical science. 

We solicit an early reply to this communication, which is 
respectfully submitted by the Faculty of the Medical College of 
Georgia." 

(Signed) L. D. FORD, Dean. 

From some few of these colleges, answers favourable to the 
enterprise were received, others declined co-operation, a third 
portion made no reply, evincing thereby no disposition for reform. 
This affords an inauspicious augury for the cause of medicine 
in our country, and we are apprehensive that some time will 
elapse before the desired changes are achieved. Those schools 
most able to make improvements in the system of instruction 
seem generally less disposed, for enjoying already the fullest 
tide of prosperity, they have least to hope from innovation. 

We are happy to learn by the address of Professor Wood, to 
the graduates at the last commencement of the University of 
Pennsylvania, that it is proposed to extend the course of lec- 
tures in that institution to six months ; but this though a decided 
improvement on the former, falls so far short of the proper 
term, that w T e would hail it rather as a practical acknowledge- 
ment of the necessity, than as an accomplishment of the required 
reformation. Among all the medical schools in the land, none 
is more competent to lead the way in the correction of errors 
and defects than that university. We regret to find that she 
is so contented with her present elevation, but hope that this 
may be the earnest of better things. 

A convention of delegates is the only feasible plan by which 
a general reformation can be effected, and unless general, it 
would militate, at least for a time, to the disadvantage of those 
first undertaking it, for many students will continue to go where 
they may find most easy ingress into the profession. We hope 
the unsuccessful attempt of the Medical College of Georgia in 
calling a convention may not deter older and more pupular 
schools from making similar efforts, to effect an object so desir- 
able and important to the interests of science and humanity. 



222 Medical Education. [Sept 

But we apprehend that insuperable difficulties and obstacles 
will oppose any plan that may be devised for a general refor- 
mation, and that some individual school that may be willing to 
suffer temporary sacrifice, with the prospect of ulterior benefit, 
must commence the enterprise. 

The medical college of this state has already commenced 
this reform, in the extension of her term ; she has sustained much 
sacrifice, and she is determined, if others do not, to lead the way 
in the correction of farther abuses and defects. 

With confident reliance on the munificent spirit of the legis- 
lature, of which they have already received such noble proofs, 
the trustees of this institution are resolved to remit no exertion, 
to spare no labour, until they establish a school of medicine on 
the proper footing — a school worthy of the bright day, the great 
and glorious nation in which we live. 

What better use, what more profitable appropriation could 
be made of a portion of the surplus fund soon to be poured into 
the public treasury, than the liberal endowment of such a school? 
What more advantageous disposition could the legislature make 
of such money, than to endow the literary and scientific institu- 
tions of the state, and especially one whose object is so closely 
and inseparably associated with the welfare and happiness of 
the people ? 

The internal physical improvement of the state is certainly 
important, and worthy the attention of the statesman and the 
patriot, but not more than its intellectual advancement ; and we 
fondly trust our wise and virtuous legislators in their zeal for 
the former, will not neglect the latter. Would they enable their 
college without sacrifice, at once to make the requisite reforma- 
tion in medical education, beside the incalculable blessing thus 
conferred upon the people by the improvement of medicine ; by 
students attracted from abroad, there would be annually brought 
into the state more money than the amount required to effect 
the purpose. 

We have intentionally confined our remarks to the four car- 
dinal defects in the present system of medical education in the 
United States, viz: the want of preparatory learning as a re- 
quisite to matriculation ; the paucity of branches taught ; the 
shortness of each session of lectures, and of the whole period of 
collegiate instruction required before graduation. The whole 



183G. ) Meteorological Observations. 223 

plan of our colleges is altogether defective and requires re-mo- 
delling. We deem it, however, unnecessary to pursue the sub- 
ject farther at present, and will conclude by pointing to the 
Medical School of Paris as a model,* and referring to a " scheme 
of a full course of elementary medical instruction,"* proposed 
by Dr. R. Coates of Philadelphia, who'has certainly suggested 
a plan as perfect as the most sanguine of his cotemporaries dare 
hope to see realized. 



ARTICLE VII. 

Meteorological Observations for Burke and Richmond Counties. 
Extracted from the Journal of a Geological Survey. By Pro- 
fessor J. R. CoTTING. 

JULY. 

Greatest heat at 12 o'clock, - - - - 9i° 

Least heat at 12 o'clock, ------ 74 

Mean heat of the first half of the month, - - 78 2' 

Mean heat of the last half of the month, - - - 75 

Mean heat of the whole month, - - - - 73 5' 



Rain guage, 5 inches, 3 lines, 
Cloudy days, - - - - 1 



Thunder showers, - - 19 
Foggy mornings, - - - 4 



Prevailing winds, N. E. and S. E. 

July 21. — There was a slight appearance of the aurora bore- 
alis, which lasted from 9 to half-past 1 1 o'clock. The corrus- 
cations were seen 30 degrees above the horizon, a little east of 
north ; not a cloud was visible in any part of the heavens. The 
21st was the coldest day of the month. 

Curve of perpetual congelation as calculated for Burke and 
Richmond Counties, Georgia, 10,193 feet. At this height water 
would continue frozen in our hottest days, for terrestrial heat 
would not effect aerial temperature at that height. 

* * The reader is referred to the second part of this number. — Editoes. 



244 Dr. Smith's Philosophy of Health. [Sept. 

Part II.— REVIEWS AND EXTRACTS. 

Dr. Southwood Smith's Philosophy of Health. 

Dr. Southwood Smith, Physician to the London Fever Hos- 
pital, &c. published in 1835, a most valuable work on the Phi- 
losophy of Health; or an exposition of the physical and mental 
constitution of man, with a view to the promotion of human 
longevity and happiness. We give the following interesting 
extract from the British and Foreign Medical Review. 

" An advanced term of life and decrepitude are commonly conceived to 
be synonymous : the extension of life is vulgarly supposed to be the protrac- 
tion oi the period of infirmity and suffering; that period which is charac- 
terized by a progressive diminution of the power of sensation, and a conse- 
quent and proportionate loss of the power of enjoyment ; the " sans teeth, 
sans eyes, sans taste, sans every thing." But this is so far from being true 
that it is not within the compass of human power to protract, in any sensi- 
ble degree, the period of old age, properly so called, — that is, the stage of 
decrepitude. In this stage of existence, the physical changes that succes- 
sively take place clog, day by day, the vilal machinery, until it can no longer 
play. In a space of time, fixed within narrow limits, the flame of life must 
then inevitably expire ; for the processes that feed it fail. But though, 
when fully come, the term of old age cannot be extended, the coming of the 
term may be postponed. To the preceding stage, an indefinite number of 
years may be added ; and this is a fact of the deepest interest to human 
nature. 

" The division of human life into periods or epochs is not an arbitrary 
distinction, but is founded on constitutional differences in the system, de- 
pendent on different physiological conditions. The periods of infancy, child 
hood, boyhood, adolescence, manhood, and old age, are distinguished from 
each other by external characters, which are but the outward signs of in- 
ternal states. In physiological condition, the infant differs from the child, 
the child from the boy, the boy from the man, and the adult from the old 
man, as much in physical strength as in mental power. There is an ap- 
pointed order in which these several states succeed each other ; there is a 
fixed time at which one passes into another. That order cannot be invert- 
ed ; no considerable anticipation or postponement of that fixed time can be 
effected. In all places, and under all circumstances, at a given time, though 
not precisely at the same time in all climates and under all modes of life, 
infancy passes into childhood, childhood into boyhood, boyhood into adoles- 
cence, and adolescence into manhood. In the space of two years from its 
birth, every infant has ceased to be an infant, and has become a child ; in 
the space of six years from this period, every male child will have become 
a boy ; add eight years to this term, and every boy will have become a 
young man ; in eight years more, every young man will have become an 
adult man ; and, in the subsequent ten years, every adult man will have ac- 
quired his highest state of physical perfection. But at what period will this 
state of physical perfection decline .' What is the maximum time during 
which it can retain its full vigour ] Is that maximum fxed I Is there a 
certain number of years in which, by an inevitable law, every adult man ne- 
cessarily becomes an old man? Is precisely the same number of years ap- 
pointed for this transition to every human being I Can no care add to that 



1836.] Dupuytreris Clinique. 225 

number? Can no imprudence take from it 1 Does the physiological con- 
dition or the constitutional age of any two individuals ever advance to pre- 
cisely the same number of years 1 Physically and mentally are not some 
persons older at fifty than others are at seventy 1 And do not instances 
occasionally occur in which an old man, who reaches even his hundredth 
year, retain as great a degree of juvenility as the majority of those who at- 
tain to eighty] 

"If this be so, what follows ! One of the most interesting consequences 
that can be presented to the human mind. The duration of the periods of 
infancy, childhood, boyhood, and adolescence, is fixed by a certain number 
of years. Nothing can stay, nothing retard, the succession of each. Alike 
incapable of any material protraction is the period of old age. It follows 
that every year by which the term' of human existence is extended is really 
added to the period of mature age ; the period when the organs of the body 
have attained their full growth, and put forth their full strength ; when the 
physical organization has acquired its utmost perfection; when the senses, 
the feelings, the emotions, the passions, the affections, are in the highest 
degree acute, intense, and varied ; when the intellectual faculties, complete- 
ly unfolded and developed, carry on their operations with the greatest vigor, 
soundness, and continuity : in a word, when the individual is capable of 
receiving and of communicating the largest amount of the highest kind of 
enjoyment. 

" A consideration more full of encouragement, more animating, there 
cannot be. The extension of human hfe, in whatever mode and degree it 
may be possible to extend it, is the protraction of that portion of it, and only 
of that portion of it, in which the human being is capable of receiving and 

OF COMMUNICATING THE LARGEST MEASURE OF THE NOBLEST KIND OF ENJOY- 
MENT." 



Extracts from the Note Book of a Physician of this City, during 
his attendance on the Parisian Hospitals. 

DUPUYTREN'S CLINIQUE. 

Case 1 . — Disease of the Spine. 

Our attention is called to two cases of diseased spine, produ- 
cing extensive abscesses, which have made their way to parts 
remote from their origin. One of the cases presents an exten- 
sive discharge of purulent matter from the upper and inner side 
of each thigh, whose passage may be traced up to the crural 
arch. The discharge in the second individual issues from the 
part corresponding to the ischiatic notch. The man first allu- 
ded to, appears to be about 35 years of age, of a good constitu- 
tion, is a baker, and of course much exposed to vicissitudes of 
temperature, and recollects having received about six years ago 
29 



226 Dupuytrerts Clinique. [Sept. 

a stroke in the small of the back, which, though painful at first, 
was not afterwards noticed. ■ About three or four years ago he 
felt severe pains in the lumbar region and was treated two or 
three years for lumbago. Six months since he entered the Ho- 
tel Dieu, with an abscess issuing from the right thigh, and after 
being interrogated, acknowledged the above particulars; and a 
short time after, the second opening appeared in the left thigh 
exactly corresponding in situation with that in the opposite mem- 
ber. His spine presents not the slightest appearance external- 
ly of disease. With respect to the second case, I will only say 
that gibbosities were here very manifest in the lumbar vertebrae, 
as it was on this point the lecturer laid most stress, in order to 
warn us not to neglect cases of long standing affections of the 
spine, (which generally assume the appearance of lumbago,) 
merely because we see no gibbosities, or external evidences of 
internal mischief. Mr. Dupuytren's treatment in these two 
cases consists of issues along the spine, and restorative drinks. 

Case 2. — Disease of the Spine, 

This case is noticed in order that we may observe another 
instance of diseased spine, presenting no local evidence of its 
existence. The patient w T as some years since much troubled 
with a cough, and other symptoms of phthisis pulmonalis, which 
finally subsided and were followed by a symtomatic abscess 
making its appearance in the lumbar region. It is known to be 
symptomatic principally from having produced externally no 
pain or inflammation previous to the issue of the matter. The 
patient having complained of rheumatic (as he thought.) pains 
in the lower dorsal region, this place was selected for the appli- 
cation of issues and moxa. 



Case 3. — Disease of the Spine. 

We have here the existence of considerable disease of the 
vertebral column, without the appearance of sympathetic ab- 
scesses. Here the gibbosities, pains of the affected region, and 
affection of the lower extremities are the existing symptoms. — 
The man's occupations were such as to expose him to frequent 
and sudden vicissitudes of temperature, which may explain the 
cause of his rheumatism of long standing. . The affection of the 
spine may perhaps be accounted for by observing, that in order 
to test his strength, he was attempting to raise himself from the 
floor by grasping some elevated object, when he heard or felt 
a cracking of the spine, about the situation of the present gibbo- 
sity. The rheumatism was translated here shortly afterwards. 
There is a scton applied on each side of the lesion. 



183G. I Dupuytren's Clinique. 827 

Case 4. — Disease of the Spine and Hydrocele. 

Tiiis man, aged 63, was admitted for hydrocele. Mr. D. 
however, observing that he had a severe pulmonary catarrh, de- 
layed any operation until this would be removed. The patient 
was bled, &c. On a succeeding visit it was perceived that he 
had a great curvature of the vertebral column, causing his chest 
and pelvis to be considerably approximated anteriorly. His 
spine on examination shewed immense gibbosities. Mr. D. at- 
tributed his pulmonary affection to the contracted space of the 
chest and thinks that an operation for hydrocele would be dan- 
gerous under the existing circumstances. The patient will be 
sent to the " incurables." 

Case 5. — Empyema caused by disease of the Spine. 

This female (about middle age) was admitted about three 
months ago with an affection of the spine. Shortly afterwards 
her breathing became affected, and gradually the dyspnoea in- 
creased to such a degree that suffocation was much dreaded. — 
At the same time it was observed, that her chest had expanded 
enormously, and that the flesh seemed to protrude between 
the ribs. Percussion and auscultation indicated the absence 
of air in nearly the whole cavity. Mr. Dupuytren believed 
there was a sympathetic abscess, which, by increasing very lit- 
tle more, would certainly render the dyspnoea so great, as to 
prove fatal. This being the case, he was on the point of mak- 
ing a small puncture in the intercostal space, when he perceived 
a manifest pulsation of the part. He hesitated, fearing the pre- 
sence of an aneurism, but the urgency of the case and the pro- 
bability of these pulsations being given to pus by the proximity 
of the heart, determined him to attempt the puncture. This 
was of course made very small, in order to prevent the admis- 
sion of air or the too sudden discharge of the matter, which 
proved to be pus. Since this, a natural and small outlet has 
appeared between the clavicle and first rib, so that the empyema 
gradually diminished daily ; the chest has assumed its natural 
aspect ; but there will remain a collapsed lung. 

Case 6. — Disease of the Spine and Coxalgia. 

This young man's history is curious; he says that having seen 
a person in a nervous attack (probably epilepsy) he was so 
much alarmed that he was taken sick and carried to Bicetre. — 
It seems that here he was treated for mental alienation which 
continued six months, during which time he was confined to the 
bed by a straight jacket. Very soon after being cured and lea- 
ving the institution, he began to feel pains, apparently of a rheu- 



228 DupuytrerCs Clinique. [Sept* 

matic nature, in the upper part of the spine and at the coxo- fe- 
moral articulation. He was admitted into the Hotel Dieu with 
large gibbosities of the uppermost dorsal vertebra? ; and to a 
shortening of the leg was added an inability to raise it from the 
bed. All motions performed by the thigh seemed to be followed 
by the pelvis. This is occasioned by the great pain produced 
by motion. The shortening of the limb is produced by a caries 
of the cotyloid cavity or of the head of the femur. Issues are 
applied to the spine and to the environs of the trochanter. 

Case 7. — Vicarious Menstruation, 

This female's sleeve having taken fire during her sleep, pro- 
duced a considerable burn of the fore and middle parts of the 
arm. This happened about two years since, and to date from 
that period, her menstrual evacuations have never assumed their 
natural course, but the time of their appearance is always 
evinced by an increase of the inflammatory symptoms of the 
diseased arm, and by the abundance of the discharge therefrom 
of purulent and sanguineous matter; for some months that she has 
been in this hospital, every means have been used in vain to 
recall the uterus to its functions. At present, leeches (4 or 5 
only) are ordered to be applied to the vulva for several days 
previous to the menstrual period and during its continuance ; 
each application to be followed by a hip-bath. The above re- 
medies for recalling the menses, though strikingly successful in 
the French hospitals, completely failed in this case, and I left 
the woman unrelieved after watching her case about a year. 

Case 8. — Wound of the Abdomen. 

A boy cleaning a table knife (sharp pointed) held the handle 
in one hand and supported the point against his abdomen, whilst 
he applied friction to the blade. In so doing he applied too 
much force to the instrument and thrust it through the abdomi- 
nal parietes. The omentum projected through the wound but 
fortunately the intestines were uninjured. The membrane was 
re-introduccd into the cavity and the wound healed by first 
intention. A few days afterwards, an abscess formed in the sub- 
cutaneous tissue surrounding the cicatrix, which being punc- 
tured discharged much pus, and finally healed entirely. 

Case 9. — Concussion, fyc. of the Brain. 

This is a painter who having fallen from his ladder, was 
picked up senseless and brought to the hospital. His breathing 
was extremely slow and soft; his pulse soft, small, and very un- 
frequent ; his pupils widely dilated and unaffected by light ; his 



183C] Dupuytren' s C Unique. 229 

limbs perfectly flaccid, so that when raised they would drop as 
if lifeless ; words and pinches were unheeded ; in this state he 
remained I believe 5 or 6 days, afler which on being pinched, 
he would withdraw the limb ; some days after, the retraction 
was accompanied by a groan, and he gradually recovered his 
faculties, so that now he converses though somewhat incoherent- 
ly, raises himself on his seat, &c. Mr. Dupuytren explained 
very lucidly the difference between a " commotion" (concussion) 
a " contusion," and a " compression" The symptoms of concus- 
sion have already been mentioned in the above case. Those of 
contusion were illustrated by a case that lately presented itself 
at the Hotel Dieu. The patient was at first stunned (to use a 
vulgar expression) by a fall on his head. He had all the symp- 
toms of concussion at first, but they soon disappeared, and the 
next day he was walking about and indulging his appetite as 
though nothing had occurred to him. On the fifth day, howe- 
ver, all the symptoms of a most violent inflammation of the 
brain manifested themselves and in despite of all remedies pro- 
duced death in 24 hours. On dissection, one half of the cerebrum 
was found of the consistence of pap, as though it had been tho- 
roughly crushed. The symptoms of compression are those of 
apoplexy and are well known to be stertorous breathing, hard- 
ness and contractedness of the pulse, paralysis of a greater or 
less portion of the body, &c. &c. Mr. D. also mentioned a case 
of concussion complicated with compression. This is an old 
woman (say 60 years of age,) who after falling into a quarry 
was brought to the Hotel Dieu in a state of insensibility, &c. as 
above mentioned. The symptoms of concussion have all disap- 
peared, but there still remains a paralysis of the muscles of the 
right side of her face. She is otherwise perfectly well. 

Case 10. — Abscess of the Mamma. 

About three months ago, this woman gave birth to a child, 
and a few days after had an abscess in one of her breasts. This 
being opened discharged much matter, and in despite of all re- 
medies the formation and evacuation of pus continues. The sound 
breast secretes an abundance of good milk and this none at all. 
Mr. Dupuytren attributes this to a vitiated state of the secre- 
tion ; that is to say, that nature having made preparations for 
the secretion of a certain portion of milk, and disease having 
occurred, the discharge of pus is kept up by the disposition that 
otherwise would have produced a secretion of milk. 

Case 11. — Predisposition to Disease. 

Mr. Dupuytren in alluding to the persons who underwent 
operations for fistula and cataracts, called our attention to that 



230 Dupuytrens CUnique. [Sept. 

peculiar state of the system denominated by him " constitution 
medicale" By this he means an aptitude or disposition to par- 
ticular diseases at particular seasons, or under certain conditions 
of the atmosphere. He remarked that about two months ago, 
he operated on six patients for cataract, and that notwithstand- 
ing all the usual preparatory means to prevent the supervention 
of inflammation, not one of them escaped its ill effects ; whereas 
two days since, the same operation was performed on four pa- 
tients, who had been prepared in the same manner as the former, 
and not one has the least symptom of inflammation, but all are 
doing quite well. Again ; there are in the hospital two cases 
of stricture of the rectum, for which the patients have been 
wearing a " meche" or pledegt of lint in the rectum without expe- 
riencing the least inconvenience ; whereas the two persons opera- 
ted on for fistula in ano on Wednesday last, are so much irritated 
by the presence of the "meche," that diarrhoea has supervened 
very much to their annoyance ; and strange as it may seem, 
they were no sooner taken with this looseness, than the bowels 
of those just mentioned as having strictures, were also similarly 
affected. 

Now Mr. D. thinks these facts good evidence of the justness 
of his opinion, that at certain periods the system of almost every 
one is predisposed to a particular affection, and that at another 
period a different disease is more easily produced. He thinks 
the subject deserves investigation, and that it would be very use- 
ful as a guide for the performance of operations, when the parts 
concerned are most free of morbid predispositions. 

Case 12. — Varicose Veins. 

This man has suffered with enormous varices of the saphena 
for many years, and about 6 years ago Mr. D. applied a ligature 
to each extremity of this vein on the right leg. The result was 
favorable, but the patient now has the other leg similarly affect- 
ed, and other veins of the right limb have also increased in size. 
Mr. D. thinks that the disease is rather aggravated than relieved 
by placing a ligature at the upper end of the limb, without pla- 
cing one also at the origin of the vein. The case before us had 
proceeded so far as to render it very difficult for Mr. D. to de- 
cide, whether the tumour about the crural arch was formed by a 
hernia or a varix. After repeated examinations, he thought of 
striking on the tumour, and at the same time observing if any 
motion was thereby communicated to the vein below, when 
finding this to be case he concluded that there was no hernia. 
He then placed a ligature at the upper and one at the lower 
extremity of the vessel. It is now about a week since, and the 
patient (having been duly prepared) has experienced no symp- 
tom of phlebitis. The blood has already " solidified in the vein'' 



1836.] 



Rostan on Diagnosis. 



231 



Rostan on Diagnosis. 



The following table (alluded to in our last number,) will be found useful 
in guiding our interrogation of the patient, and recording the history of his 
disease. °It is scarcely necessary to say, that we will seldom or never be 
obliged in any one case to propose as many questions as are here suggested. 

Sex, age, constitution, menstruation, health, antecedent diseases and treatment 
supposed causes, parentage, invasion. 



EXTERIOR HABIT OF EODY. 



HuDger 



digestion. < Thirst 



Taste 



augmented, 
diminished, 

perverted, 



increased, 
diminished, 
abolished, 
perverted, 



bitter, 

clammy, acid, 
sweet, &c. 
mouth drv, 



form, 

position, 

colour, 

consistence, 

temperature, 

sounds. 



of the head, 
" neck, 
" chest, 
« bellv, 
" limbs, 



teeth, gums, 
f volume, form, 
j position, con- 
tongue^ sistence, 
| colour, 
Lfurr. 
Mastication, deglutition, 
(stomachal digestion, nausea, 
vomiting, matters vomited, 
epigastric pain, tumours, bor- 
borygmi, flatulency, dejecti- 
ons, constipation, diarrhoea. 



'"frequent, rare, 

quick, slow. 

arterial large, small. 

circucation. < stony, feeble. 

pulse. hard, soft. 

equal, unequal, 

^regular, irregular, intermittent, confused, insensible. 

heart. Its shock, palpitations, sound, rythm. 



VF.XOUS 
CIRCULATION. 



RESPIRATION^ 



State of the veins, 

Qualities of blood drawn from veins. 

frequent, unfrequent, equal, unequal, 
quick, slow, easy, difficult, anxious, suffocating, 
deep, small, laborious, painful, 
puerile, inaudible, sonorous, noisy, &c. 
C crepitating, 
rale, 2 mucous, guggling, 

( sibilant, dry, sonorous, &c. 
laughter, yawning, hiccough, 
C frequent, unfrequent, 
cough, 3 easy, difficult, 

( laborious, painful, humid, dry. 
^expectoration, matters expectorated. 



232 



Rostan on Diagnosis. 



[Sept. 



O 

H 
O 

o 

I— I 

c 

pel 
O 



CHEST. 



EXHALATIONS. 



SECRETIONS. 



ABSORPTIONS. 



NUTRITION. 



SENSATIONS. 



sound 



C dull, 
f clear. 



of the skin, 

of the serous membranes, 

of the mucous " 



partial, general, 
natural, morbid,accidental 
increased, diminished, 
abolished, vitiated. 



tears, 

saliva, 

bile, pancreatic juice, sperm, urine. 

augmented, 

diminished, 

resolution of diseases, 

atrophy, 

hypertrophy, &c. general, partial. 

sensibilitv \ £ eneraJ ' augmented, 
sensibility, ^ partial> diminished, 

pain. 



z 
o 

o 
fa 



n 



"vision, f 

audition, | augmented, 
senses. ^ smell, J 

j taste, ] diminished, &c. 
Uouch, (._ 
C augmented, 
intelligence 1 diminished, stupor, idiotism, 
I perverted, delirium, &c. 
/ somnolence, 

coma, / 

carus, 

lethargy, dreams, night-mare, &.c. 

convulsions, contraction, rigidity, cramps ? 

numbness, 

paralysis, 

tremors, &c. 



SLEEP. 



MOTIONS. 



ORGANS 
OF LOCOMOTION. 



VOICE, 
SPEECH. 



GENITAL 
FUNCTIONS. 



increased, 

diminishd 

abolished, mute, aphony, &c. 
( pectoriloquy, 

perverted, 1 egophony, 
^ ( metallic tinkling, 

C menstruation, ( augmented, 
} lochica, ( diminished, &c. 

( lactation, 



1836.] The Doctor. 233 



The Doctor. Republished by Harper & Brothers, New-York. 

The above, is the title of one of the most incongruous, absurd, 
and nonsensical publications, that was ever issued from the 
press. We are glad it comes from across the waters ; and our 
only regret is, that it was not quashed upon reaching our shores. 
The Harpers ought not to have republished it ; and we, insigni- 
ficant as we are, would not now notice it, were it not that some 
sage critics have pretended to see wit and humour in it, and 
that we have now before us a review of the Doctor in the Sou- 
thern Literary Messenger. 

While on our passage from Charleston to New- York, in a 
steam-packet, a few weeks ago, our attention was called to the 
Doctor, by a lady passenger who had been reading it with great 
apparent gout. Upon replying negatively to the question, if 
we had read it, the work was kindly put into our hands. A 
few moments perusal and examination of it, satisfied our com- 
mon sense, and it was laid aside with distrust. Subsequently, 
circumstances forced us to become the owner of this work, but 
we assure the reader, it was for only a very short period, du- 
ring our passage from Norfolk to A ugusta. 

But to the object of this publication — the Doctor. No one 
has pretended positively to know what is its meaning, what is 
its purpose. Neither are we better informed as to its author, 
or, as some imagine, authcrs. We are rather inclined to the 
opinion, that it is a hoax ; and we perfectly coincide with the 
reviewer in the Literary Messenger, that its meaning is precise- 
ly — nothing. We must also believe one man alone wrote it, 
at least we hope so — and another thing, that that man w r as no 
Doctor! To say the author is, would be a scandal to the pro- 
fession of medicine. 

The Doctor professes to contain two volumes in one cover. 
We have only looked over some pages of the first, and from 
them, together with extracts, &c. which we have seen, have 
derived our impression of the nature and character of the pub- 
lication. As the Messenger has it, volume one commences 
with a Prelude of Mottoes occupying two pages. Then follows 
a Postscript — then a Tahle of Contents of the first volume, occu- 
pying eighteen pages. Volume two has a similar Prelude of 
Mottoes, and Table of Contents. The whole is subdivided into 
chapters ante-initial, initial and post-initial, with inter-chapters. 

The pages have now and then a typographical queerity — a 
monogram, a scrap of grotesque music, old English, &c. To 
complete this description, we must add these figures, resem- 
bling triangles, pyramids, or even the Egyptian hieroglyphics ; 
and the book contains the life of Dr. Daniel Dove and his horse 
Nobs. At least this is its profession. 
30 



234 French Medical Institutions. [Sept. 

Now to some, all this may be wit or humor, but to our hum- 
ble conception it is neither. The book may contain something 
good or useful, but we never expect to derive either from it. — 
Certainly we shall never attempt to read it again. We feel 
persuaded that much of the attention and the sensation said to 
be created by it is owing to its foreign growth. We would not 
even be surprised if it has beeir gotten up for the purpose, seeing 
to what extent and to what success Jonathan can be gulled by 
John Bull. 

Be all this as it may, we venture to say the book is a libel — 
the Doctor, no Doctor. We repeat, such a work ought never 
to have been published, it can answer no good end. 

Although this is not a professional book, we have been in- 
duced to make this brief notice of it, to save our readers the 
expense of purchase, and the task of perusal. P. F. E. 



[From the British and Foreign Medical Review.] 

Extract from a review of Mr. Lee, on the Medical Institu- 
tions of the continent. 

French Medical Institutions. 

" A clear and good account of the Parisian hospitals is given (in pages 2 
and 3) : we think, however, that it is not correctly stated that all the hos- 
pitals are attended by the sarnrs de la cliarlie as nurses : this, however, is 
of small importance : the question of their efficiency is more material. — 
Few students see the wards of foreign hospitals except during the visit of 
the physicians or surgeons. In the absence of these, the general service of 
some of the French hospitals is, we know, performed in a very slovenly 
manner. We have been surprised to see the house-pupils performing all 
the minor operations, including venesection, unattended by any nurse, even 
in the women's wards ; and in case a patient fainted, it was sometimes ne- 
cessary to summon the aid of the man who was polishing the floor by rub- 
bing a cloth over it with his foot. Not a sccur de chante was then to be 
seen. Neither did it appear to us that these sisters were remarkable for 
the gentleness of their manners. We made these observations with regret, 
and in opposition to all our previous impressions ; and the conclusion to 
which we came was, that ordinary nurses, with all their defects, were more 
efficient hospital attendants, such offices "pour l'amour de Dieu" being 
little better than certain tonsorial services recorded among authentic face- 
tiae as performed for a like consideration. 

The following is the prescribed course of study for those who take the 
diploma of Doctor in medicine or surgery in Paris : 



2d 


ditto. 


3d 


ditto. 


4th 


ditto. 


5th 


ditto, 


6th 


ditto. 


7th 


ditto. 


8th 


ditto. 



183G.] French Medical Institutions. 235 

" Candidates for the diploma of Doctor in Medicine or Surgery, are re- 
quired to have studied four years, during which period they have to take 
out an inscription every three months for attendance on the lectures and 
hospitals. Members of foreign colleges and universities may, however, 
present themselves for examination after two years' study in Paris. The 
scholar year begins on the 1st of November, and terminates on the 31st of 
August. The expense of the course of study required for taking a degree 
does not exceed a thousand francs (£40.) 

" The following is the prescribed order of study : 

1st half year. Anatomy, Physiology, Chemistry. 

Medical" Physics, Hygiene, Medical Natural History. 

Anatomy, Physiology, Operative Surgery. 

Hygiene, Medical Pathology, Pharmacy. 

Operative Surgery, Medical and Surgical Pathology. 

Clinical Medicine, Clinical Surgery, Materia Medica. 

Clinical Medicine, Clinical Surgery, Medical Pathology. 

Medical Jurisprudence, Therapeutics, Obstetricity. 

" The examinations for the diploma are five in number. The first takes 
place after the fourth inscription has been taken out ; the second after the 
twelfth inscription ; the three remaining examinations take place at the 
termination of the course of study, 

" The subjects of the first examination are, natural history, physics, me- 
dical chemistry, pharmacology ; 2d, anatomy and physiology ; 3d, general 
pathology, medical and surgical pathology ; 4th, medical jurisprudence, hy- 
giene, materia medica, and therapeutics ; 5th, clinical medicine and surgery, 
•operative surgery, obstetricity. 

" Each examination lasts two hours, during which four candidates are 
questioned by three examiners. 

* For the anatomical examination the candidate is required to make a 
preparation from a part of the body, which is indicated to him on the same 
morning, and to answer questions proposed to him relative to the prepara- 
tion. Candidates have also to write and defend a thesis on some point re- 
lative to medicine or surgery. The clinical examinations take place in the 
clinical hospital at the bedside of patients. The examination fees amount 
to one hundred and fifty francs." 

The examinations, we may add, are public, and searching and efficient, 
but conducted with politeness. 

In France the profession is divided into physicians, surgeons, and a low- 
er rank of practitioners called officers of health (officiers de sante,) the 
practice of the latter being nominally restricted to cases of minor importance: 
we say nominally, for the restriction is plainly impracticable. Midwifery 
is chiefly in the hands of women, and although they are regularly educated, 
we think that a suspicion expressed by Mr. Lee, that this circumstance has 
some connexion with the great frequency of uterine diseases in France, is 
not quite unfounded. There are lying-in charities in our own country, in 
which from a spurious delicacy, women only are employed as midwives, 
and we have seen much of the bad effects of this regulation : it is however 
to be considered, that our English midwives are uneducated persons. — 
" Apothecaries," says Mr. Lee, " are not allowed to prescribe, their busi- 
ness being confined to the selling of drugs, and the preparation of prescrip- 
tions, as with cliemists and druggists in England :" who, it may be added, 
do not so confine themselves at all, but practise very extensively. 

" Mr. Lee's account of the state of msdical practice in France is succinct 
and interesting : it is evident that French physicians are becoming less go- 
verned by theory, and more guided by symptoms : or, in other words, that 
the practice among them is becoming more rational. Since the publication 
of the opinions of M. Broussais, bleeding has been more boldly resorted to ; 
but the French seem negligent of following up bleeding by medicines calcu- 
lated to amend the secretions, or even to remove vitiated accumulations ; 



286 French Medical Institutions. [Sept. 

the consequence of which is that symptoms arise which appear to call for a 
repetition of the bleeding, and patients are sometimes bled and starved to 
death. We believe this even not to be very unfrequent in fever cases, and 
Mr. Lee gives a striking case of typhus in illustration of it. M. Louis and 
M. Andral should be mentioned, however, and are so, by Mr. Lee, as excep- 
tions to this practice ; both of them employ saline purgatives and other me- 
dicines in such cases. The more frequent and varied employment of baths 
in chronic diseases appears to be advantageous in French practice, and is, 
we think, beginning to be attended to in this country. Mr. Lee very pro- 
perly thinks that " the practice of abstracting blood and applying irritants 
at a considerable distance from the seat of the disease, on the principle of 
revulsion, might be more frequently adopted with advantage in England, 
especially in affections connected with cerebral irritation or congestion." — 
A small bleeding from the ancle, a few leeches applied to the thighs or arms, 
especially to the latter, blisters to the legs, sinapisms to the feet, &c. arc 
often singularly useful ; and it is certainly to be regretted that English 
practitioners are often so inclined to condemn measures of this kind as tri- 
lling ; we mean, of course, only in chronic cases. 

" In the treatment of burns and scalds, stimulating applications are less 
used on the continent than in England : bleeding, opium, cataplasms, or 
emollient dressings, being the usual means employed. Whatever is the 
seat of the injury, the application of ice to the head for an hour or two is 
strongly recommended ; its effect being to cause a cessation of pain, and to 
prevent cerebral symptoms. 

" Under the head of each Parisian hospital, a concise account is given of 
the practice of the medical officers, and this is illustrated by occasional ca- 
ses. We can only find space for a few brief extracts from this interesting 
part of the work. 

"The hospital La Pitie has the advantage of the services of some of the 
greatest men in Paris, MM. Louis and Andral being the physicians ; and 
MM. Lisfranc and Blandin the surgeons. M. Lisfranc is well known to 
English students for the boldness and dexterity of his practice, especially in 
cases of diseased uterus." 

" M. Lisfranc has charge of two men's and a women's ward, most of the 
cases of the latter being marked as disease of the uterus ; many of these 
patients are, however, young women affected with superficial erosion of the 
cervix uteri, and are cured by a few days' rest and appropriate treatment ; 
the means resorted to in these cases, as well as in ulceration of this part, 
being chiefly confinement to the recumbent position, occasional venesection 
to three or four ounces, on the principle of revulsion, small doses of cicuta, 
and cauterization with a solution of mercury in nitric acid every six or eight 
days : when the ulceration is of a cancerous nature and too deep to be re- 
moved by cauterization, M. Lisfranc has recourse to excision of the cervix 
Uteri ; this part being exposed by the speculum, and firmly seized by pimces 
d», musmux, is brought down beyond the orifice of the vagina and excised 
with a knife, as in cases of polypus. M. Lisfranc has met with more than 
four or live cases of dangerous hemorrhage after this operation, the symp- 
toms which supervene being mostly of a nervous character and sometimes 
alarming, but mostly yield (yielding) to sedatives. Of ninety-nine cases in 
Which he operated, eighty-four recovered ; many of these patients became 
subsequently pregnant, and experienced no particular inconvenience in 
parturition." 

f Mr. Lee adds, whal few will doubt, that the operation has been perform- 
ed in many cases in which it might have been avoided. M. Lisfranc treats 
phlebitis (supervening on venesection) by emollient fomentations and cata- 
plasms on the inflamed pari, with the repealed application of leeches be- 
tween the point where the inflammation terminates and the heart ; and he 
states, that since he adopted this practice, he lias not lost a single patient 
from this disease; whereas when he employed other incans, and applied 



1836.] Dr. Coated Scheme of Elementary Instruction, 237 

leeches near the wound or over the inflamed vein, the majority of cases ter- 
minated unfavorablv. 

H MM. Alibert and Biet, the physicians to the hospital of St. Louis, are 
also well known to English practitioners ; the first by a splendid publication 
on diseases of the skin, the second by his enlightened practice in cutaneous 
scrofulous, and malignant affections. The opinions of M. Biet on the use 
of Baths in cutaneous diseases may be useful to the English reader." 

" Simple tepid baths are most beneficial in the dry scaly forms, though 
only as an accessory means ; their efficacy is less marked in the pustular 
varieties : they are serviceable in vesicular affections when the inflamma- 
tion begins to" decrease, and may be used with advantage in impetiginous 
affections where incrustations have succeeded to the pustules. 

"Alkaline baths are efficacious in the" papular and dry scaly forms, and 
in the impetiginous and tubercular varieties. An alkaline bath may be 
formed by dissolving in a simple bath from half a pound to a pound of car- 
bonate of soda. 

" Sulphur baths are most useful in the decline of vesicular affections ; 
they are less useful than alkaline baths in the chronic stage of psora, and 
if used in the inflammatory stage the symptoms are aggravated. Sulphu- 
rous baths are composed of two ounces of diluted sulphuric acid and eight 
ounces of hydro-sulphuret of potass added to each bath. 

" Acid baths may be made by adding to each from four to eight ounces 
of hydro-chloric acid ; they are mostly applicable in dry scaly eruptions." 

" In the account of the Hopital des Enfans Malades, we perceive that 
the mortality among the unfortunate children is stated to be one in four, 
which we believe to be rather under than over the truth. According to 
our own painful observation, this horrible mortality is to be ascribed, in a 
great measure, to the expectant system of medicine ; to starvation, and 
gum water, conjoined with the too free use of leeches. 

" M. Civiale, whose name is familiar to us in connexion with lithotrity, 
has a small ward in the Necker hospital, and the following is mentioned in 
the account of his practice." 

" Paralysis of the bladder, and vesical catarrh, in elderly people, are trea- 
ted in the following manner : — a stream of cold water flows from a reser- 
voir fixed near the ceiling, through an elastic gum tube, having stop-cocks, 
and terminating in a silver catheter formed into a double tube by a central 
partition. The patient being in the recumbent position and the catheter 
introduced, the water passes into the bladder by one side and out by the 
other. A continued stream of water through the bladder is thus kept up 
for about ten minutes, and repeated every second or third day : the quanti- 
ty of water passing into the bladder may be regulated by the stop-cock, so 
as to prevent undue distention. The beneficial effects of the method are 
attributed to the clearing away of the accumulated mucus, and to the tonic 
action of the cold water upon the bladder." 



Sclieme of a full Course of Elementary Medical Instruction. By D. Ret. 
nell Coates, M. D. of Philadelphia. 

The following outline of the natural classification of the principal branch- 
es of Medicine which should be taught in Collegiate and Subsidiary Schools, 



238 Dr. Coated Scheme of Elementary Instruction. [Sept. 

arranged according to their mutual dependence, and proper order of suc- 
cession, is here given at the request of a few scientific friends. The scheme 
is not founded upon the existing systems of this, or any other country, but 
upon an analysis of the great divisions of the Science, and its collateral ra- 
mifications. 

COLLEGIATE STUDIES. 

I. Natural History of Man in Health. 

Ph G S try ' \ Two sll0rt Courses ' " " " -One Professor. 
These branches relate to the agents which act upon the living body ac- 
cording to mechanical laws, and should be taught with special reference to 
medicine. As a very large majority of students of medicine commence 
their studies in this country while extremely ignorant of these subjects, 
they cannot be regarded as part of their previous education, but must be 
taught in the collegiate schools. 

SpTckf An" tomy!' \ ° ne shor ^ and 0ne lon 2 Course ' ° ne Professor. 

Under the first of these heads should be included such a view of Compa- 
rative Anatomy as is necessary for the student of the elements of medicine. 

II. Science of Healthy Vital Operations. 

Physiology. One great Course, - -- - One Professor. 

III. Natural History of Disease, and Science of Diseased Action. 

g^of fcttK^e.. \ °« e ^ <*u*e, - One Professor. 

Pathological Anatomv, and J nna , n««— r* -n t 

r> ,i i ° rr , i tv > Une long Course, . One Professor. 

Pathology of External Diseases. $ fe ' . 

It may be remarked that it is difficult to separate Pathological Anatomy 
from Special Pathology, as is done in some European schools. We think 
the effect of such a division injurious, if not unnatural. 

IV. Natural History of Remedial Agents. 

Materia Medica, One long Course, - One Professor. 

V. Art of Healing. 

Therapeutics of Internal Diseases. One long Course, One Professor. 

Clinics of Internal Diseases. One long Course, - - One Professor. 
Therapeutics of External Diseases. } 
Surgical Anatomy and Operative >Two Courses, - One Professor. 

Surgery. ) 

The two or rather the three last brandies arc properly thus arranged ; 
because Surgical Anatomy cannot be properly detached from Operative 
Surgery, unless mad.' a distinct, professorship, for which it is too limited. — ■ 
Operative Surgery is obviously a Therapeutic branch, and the .Materia 
Chirurgica cannoi be separated from Surgical Therapeutics and the Surgi- 
cal Clinic ; it is therefore left for tacit division between them. 

Clinics of Exlerna! I) One Professor. 

Obstetrics, } 

Diseases of Women and >T\vo Courses, - - One Professor. 

Children within the year. ) 



I83G. | Dr. Coalcs' Schema of Elementary Instruction. 239 

VI. Art of Preserving Health. 

Hygiene. One short Course. 

This branch scarcely deserves a separate professorship in tins country, 
and may be associated with Medical Jurisprudence and Police, with which 
public Hygiene is closely associated. 

VII. Medico-Legal Relations. 

Medical Jurisprudence, > Q Q _ . Q Professor, 

Medical Police and Health Laws. C ' 

Number of Branches — 17. - - Number of Professors — 12. 

Such an arrangement, we think, covers the ground of a good Collegiate 
School, ami no more. If compelled to contract the list of branches, we 
could part with none but Hygiene. If compelled to lessen the number of 
Professors, we could only effect our purpose by associating the duties of the 
Clinical chairs with those of the Therapeutical chairs ; by which means the 
number would be reduced to ten, at the expense of imposing four heavy and 
scarcely compatible tasks on two individuals, with the additional disadvan- 
tage of being compelled to choose our teachers of the two most important 
theoretical branches, from the slender list of Hospital Practitioners, whose 
habits and engagements often render them incapable of executing such du- 
ties. Moreover this contraction of the scheme would tend powerfully to 
destroy the independence of opinion which should always characterize the 
medical student. 



The proper object of a Collegiate course is the inculcation of correct ele- 
mentary medical knowledge, such as is necessary for every young practi- 
tioner ; but there are many other subjects of public medical instruction, 
which are necessary or highly desirable for medical men in peculiar situa- 
tions, and for persons prosecuting particular researches. These subjects 
should be taught in Subsidiary and collateral schools. Some of the most 
important of these are as follows : 

Practical Anatomy. — Subsidiary to the Anatomical, Physiological, and 
Surgical Chairs. 

Pharmacy, Pharmaceutic Chemistry, Chemical Manipulations, and Botany. 
— Subsidiary to the Materia Medica, and referable to the College of Phar- 
macy. 

Comparative Anatomy. — Referable to the Academy of Natural Sciences. 

Diseases of Children. Diseases of the Chest. — Extensions of the Medi- 
cal branches, and referable to the Clinical schools. 

Diseases of the Eye and Ear. Diseases of the Skin. Orthomorphic Treat- 
ment. Minor Duties of Surgery. — Extensions of the Surgical branches, 
and referable to the Clinical schools. 

Transcendental Anatomy and Physiology. Medical Etiquette, and Medi- 
cal Ethics. History of Medicine, and ^Medical Biography. — Referable to 
Private Lectures, under the patronage of the College of Physicians. 



2 10 The Western Medical Reformer. [Sept. 



The Western Medical Reformer. 

Our printers placed in our hands the other day a printed pa- 
per of eight leaves, purporting to be The Western Medical 
Reformer — called also by the editors A Monthly Journal of 
Medical and Chirurgical Science. (!!!) This paper printed at 
Worthington, Ohio, last July, and being the 7th number, ap- 
pears to have commenced its career under the auspices of this 
bissextile — an ominous season truly. It is a year in which the 
odd hours of the four last are manufactured into a new day, and 
adopted on the last end of February ; and which makes the 
year 1836. Now it has been generally understood, that a year 
contained 365 mean solar days : and certainly it is true ; but 
this peculiar time gives it of course 366 days. 

Years of this curious kind have been observed before ; and 
have been supposed to posses peculiar virtues, in the way of 
reversing the common order of things. Some have believed 
that waters have on those occasions reversed the laws of gra- 
vitation and run up-stream, particularly about Whitsuntide. — 
Others say that Caesar made it by appointing that the 24th of 
February should be twice numbered ; and thus was formed an 
intercalary day, corresponding with the sixth of the calends of 
March, long celebrated by the Romans on account of the ex- 
pulsion of Tarquin. Others believe that it leaps over one day 
in the week, so as to not alter the day of the week from that of 
the month, as in other years. Others again have thought that 
Venus sallied forth, wresting from its rightful owner the bow 
and quiver, and claiming them for her own, dispenses the mis- 
siles of love to Cupid's own heart, now made vulnerable to her 
attacks by the wonderful agency of that which reversed the natu- 
ral order of things. An easy transition from this, of only half a 
step, has enabled young maids, by virtue of a superior elective 
affinity which this year dispenses to them, of power to overrule 
all prior affinities in exercise between bachelors and their books, 
business, or fair ones, to become successful suitors for matri- 
mony ; and old matrons, the menstrua for dissolving together 
the heterogeneous elements of the two sexes into one homoge- 
neous compound. 

When we contemplate the wonders of leap year, in presiding 
over the expulsion of the Tarquin family from Rome, to whom 
she was so much indebted for her splendor, magnificence and 
power ; and when we behold its wonder-working transposition of 
the natural order of things — rendering the weak strong, and the 
strong weak, &c. we think we arc brought by the very easy 
gradation of another half step to sec why some men beyond the 
alleghany have been inspired to embark in the wonderful enter- 



1S36.] The Western Medical Reformer. 241 

prise of overturning all science. Why medical science has 
sprung up on the impregnable basis of nature's truth — risen 
through seas of primeval simplicity, stupidity, presumption and 
knavery, and stands like the Andes, in the midst of mighty wa- 
ters, and crowned like these, with undissolving honors. And 
do we see on the sea beaten granite of its wide base the vermin of 
equivocal generation erecting their mucous domicils in the recess 
of the surges which try the strength of foundations, and calling 
them truths? Or do we behold the vampires of knavery, seek- 
ing the treasure and the blood of the weak and unwary? 

Now these men surely believe in their simplicity ; or pretend 
in their knavery ; that stupidity will become philosophy and 
philosophy will become stupidity — that falsehood will become 
truth, and truth become falsehood — that sin will become righte- 
ousness, and righteousness become sin, by the wonderful trans- 
muting virtues of leap year ! They have herded themselves 
under the wing of the literary institution of Worthington, (whose 
trustees should have had more sense.) and tell us that medical 
degrees will be conferred on the judgment of men w r ho deny the 
Jirst and all principles of science ; and not only so, but men who 
either in their simplicity or knavery, prop up falsehood — ruin- 
ous falsehood, at the expense of all truth and humanity. 

The first part of this redoubtable " Western Medical Reform- 
er" is expended in telling us what Dr. Morrow told a committee 
of students, he liked, and what he disliked ; and of course, the 
same of his college* — owning that the same medicines mainly 
are used, but denying deriving their notions from the steamers. 
Then we are furnished with a bird's eye view, condensed from 
matter enough of the same kind, to make an octavo of 800 pa- 
ges, of his reasons for differing from the old school. 

We cannot spare room for quotations of such stuff, as only 
tends to prove that the man knows nothing of the " old school," 
as he pleases to call scientific physicians ; but one short speci- 
men taken from the beginning of a paragraph which strikes the 
eye without selection, as we look from the pen, w T e beg indul- 
gence of the reader for giving. After condemning all minerals, 
he says : — 

" It is well known that the various preparations of mercury, 
arsenic, antimony, iron, bismuth, &c. are regarded as the Samp- 
sons of the materia medica of modern fashionable practice ; not- 
withstanding the operations of these agents are evidently injuri- 
ous to health and life." &c. 



* A "committe of students, it appears, entertained a suspicion, and not 
without much reason, that this "reformed college", were a mess of the 
disciples of Thomson and Howard, and questioned the principal (whom we 
suppose Dr. Morrow to be, as he appears to return the answer) on the 
point. 

31 



242 The Western Medical Reformer. [Sept. 

When thought gets to the boundary of knowledge, it requires 
some energizing influence to arouse it to step beyond this terra 
firma, into the next territory which is the terra incognita. In 
all our perambulations in aetiology, we have found but two ac- 
tive powers sufficiently potent for this purpose. One of these 
is an ignorance, too profound to know that it is necessary to 
look, before leaping. Another is a knavery which would em- 
bezzle the very liv'ng, by entombing the mental energies of the 
weak though honest. 

There is a truism contained in the expression, 

« What can we reason from, but what we know V* . 

which is a key admirably suited to the purpose of unlocking the 
casement of a man of letters, and shewing the interior ; whether 
the casement be an A. JVJ., or D. D.; or an L. L. D. or M. D. — 
With this key in hand we need, so long as truth is truth, and sci- 
ence is science, no more help to know a little more of some 
men, than they know of themselves; and determine pretty pre- 
cisely their differential attitude, than only to see them publish 
their views on some of the common place topics. We see at 
once the overwhelming of Nubian sands, or the ingulfing of the 
dark deep waters. And as effects prove cause, our conclusion 
is unavoidable, that these arise from one of the two only com- 
petent active powers ; for in reasoning from effect to cause we 
can only reason from "what we know." 

We should not have noticed so far, this miserable production, 
but for observing a full page spent in lauding lobelia inflata as a 
medicine of such virtues, as are calculated to call it into hourly 
use. We know but few things of practical importance about 
lobelia ; but we do know amongst these few things that long 
since, physicians who have both knowledge, and feelings of hu- 
manity, have laid it aside on account of its uncertainty, and its 
dangerous power, to which they have resorted only under very 
peculiar circumstances. Our chief practical knowledge of its 
powers which have compelled regular practitioners to deprecate 
its use, has been derived from observations on numerous cases 
to which we have in these latter years been palled, for the pur- 
pose of endeavouring to remedy its peculiarly ruinous effects on 
the digestive and nutritive powers, and on the general constitu- 
tion. These lead us to mourn over the manslaughtering use of 
it which has become so common, whenever we reflect, as we 
often do, on the scene of misery and ruin which we have seen 
entailed on the bereaved husband, the disconsolate widow, the 
orphan child, and the last hope of the parent. 

This is no new article in the materia medica ; but a stupidi- 
ty and hard heartcdncss which can kill — yes, kill, often in twen- 
ty minutes, any and all orders of mankind, and continue the 
practice for years, and not be able to see, mourn over, and/07*- 



1836.] The United States Medical and Surgical Journal. 243 

sake the ruinous course, is a novelty in the profession which 
has been reserved for the Thomsonians and the " reformers." 

Lobeliv stands before the profession chiefly a beacon to tell 
where danger lies. Its name is looked on by those who really 
hnow its powers, almost as the poisonous atmosphere of the 
Upas — to be avoided ; or, if approached at all, with the greatest 
circumspection. 



The United States Medical and Surgical Journal. 



The number of this work- for June 1836, is before us. Hi- 
therto we have not been so fortunate as to have seen the United 
States Medical and Surgical Journal. 

We have experienced no small degree of surprise on seeing 
this periodical — not from what we would call positive faults, 
but negatives. Before we saw it, we measured it in all res- 
pects by the mighty state and city from which *it emanates. — 
We had often contemplated with pleasure the beautiful medi- 
cal organization of the whole state of New- York, by county 
and state societies ; and when we beheld the professional zeal, 
and excellent police, concentrate their rich and abundant me- 
dical commodities into one point — the great state society, which 
would provide means for dispensing the same to the medical 
world. 

We would not be uncharitable towards the constituents of 
that great medical community, and we will cherish the hope, 
that still some plan is in way of maturation, whereby the trea- 
sures of medical observation, experience, and mental research, 
which that extensive, enlightened, and well organized medical 
community must possess, shall cease to be lost to the world. 

But men are apt to form opinions, by the facts before ihem: 
and should we judge by the specimen of the United States Me- 
dical and Surgical Journal, which is before us, — a small month- 
ly (we suppose, for we are not told) of about forty pages, filled 
with valuable matter surely — but all foreign; and without hav- 
ing attached to it the professional responsibility of any particu- 
lar man or set of men, but said to be conducted by " a number 
of respectable physicians," and left to a publishing agent, we 



244 On the Chemical condition of the Saliva, eye. [Sept. 

should be led to fear that the eye of the medical police of New- 
York has been directed mainly to the cash income, instead of 
medical science. We will hope that a new effort will be made, 
that the societies will carry into effect the great purposes of 
their organization, and set" a system in operation which shall 
pour at once into the lap of responsible professional ed:tors, 
their valuable matter; and that the United States Medical and 
Surgical Journal, may soon appear before the world swelled 
and enriched by an abundant store of medical valuables. 



On the Chemical condition of the Saliva, as an indication of the 
different murbid affections of the Stomach. 

No one thing in the practice of medicine, or in the philosophy 
of pathology can be of more vital importance than diagnosis. 

The introduction of the physical signs of auscultation and per- 
cussion is justly hailed in Europe, England and America, as a 
brilliant era in medicine. We hail with joy of the same kind 
the recent introduction of chemical evidences in aid of this im- 
portant branch of pathology. Indeed if we contemplate the 
practical utility of the diagnosis which we are about to notice, 
should it be well confirmed by future experience, (which we 
honestly believe will be the case.) we may look on M. Donne 
as having bestowed on the science, a greater benificence than 
Avenbrugger or Laennec. We say a " greater beneficence," 
not only because the diagnosis is m febrile — the most extensive 
class of diseases, which spares no country, and by which the 
great sum of mortality is mainly marked annually; but also be- 
cause this diagnosis is available for good. We would not 
depreciate the value of auscultation, or percussion. The clear- 
ness and accuracy to which they lead are in wortli beyond cal- 
culation. But how often does it happen that the diagnosis to 
which these lead, cannot furnish us with any new remedial 
means, or only enables us to make more accurate prognostica- 
tions, or withhold many useless doses ! It is available for good 
in more ways than one. It places at once the practitioner in 
the true road to success in a disease generally curable ; and 
wherein the ill success has been chiefly attributable to errone- 
ous views of the nature and seat of the disease, or the patho- 
logical condition. 



1835.] On the Chemical condition of the Saliva, $c. 245 

Such is in our estimation the deep interest attached to every 
effort for the improvement of diagnosis, and such the novelty of 
the subject of the following, that we cannot withhold from our 
readers any part of the notice of M. Donne's experience in the 
testing of saliva for diagnosis. 

[From the Mcdicc-Chirurgical Review.] 

« M. Donne is well known in Paris as one of the most zealous and intel- 
ligent vouno- physicians there. For several years he was clinical clerk to 
M. Louis, as our readers may have learned from the foreign Periscope of 
our Number for July last ; and subsequently he attached himself very en- 
thusiastically to the service of M. Bouillaud" in the wards of the great H6- 
pital La Charite. 

" The pages of the Journal Hebdomadaire for the last three years attest 
his great activity as a diligent and enlightened observer of disease. For 
some time past he has been engaged in collecting materials for a work on 
the Chemical Properties of the Animal Fluids in Health, and also during 
the progress of various morbid affections. 

« One branch of the subject appertains to the investigation of the changes 
which the saliva undergoes in disease, and more especially in that form of 
it, which has been of late years far too indiscriminately designated gastro- 
enteritis. Although a devoted disciple and admirer of M. Bouillaud, (who 
is generally considered as one of the most ardent and able followers of the 
physiological or Broussaian doctrine,) he candidly admits that a multitude 
of stomach affections, differing greatly in their characters, and requiring 
verv different m -des of treatment, have been most erroneously grouped to- 
gether under this very much abused epithet. Numerous are the cases, 
where patients have been tortured with the long continued but ineffectual 
use of antiphlogistics and refrigerants, and where a few doses of emetics 
and purgatives' subsequently have dissipated all distress in the course of a 
dav or two. The diagnostic symptoms between the genuine " gastro-en- 
terite," and mere ■ embarrass gastrique," hitherto pointed out by medical 
writers, are indeed, it must be confessed, often unsatisfactory and even de- 
lusive • and it has been owing in a great measure to this very uncertainty, 
that the exclusive doctrines first promulgated by Broussais have been car- 
ried to so extravagant a pitch by one party, and condemned so indiscrimi- 
nately bv another. 

" It is with the hope of dispelling part at least of this uncertainty, that 
M. Donne has ingeniously proposed the chemical state of the saliva as the 
means to determine the real character of various stomachic diseases. 

"He premises his remarks by alluding to those excellent observations of 
M. Andral, wherein he states "that no relation can be established between 
the existence of nausea and vomiting, occurring during the progress of fe- 
vers, and any lesion of the stomach appreciable on dissection ; for, on the 
one hand, these symptoms have been often absent, when the stomach has 
been found • le plus rouge et le. plus gravement affecte ;' and on the other 
hand, when they have been present, often no morbid change of the viscus 
is discoverable after death. The mere existence therefore of these symp- 
toms in fevers is no proof of even irritation, far less of decided inflammation 
of the stomach. 

" Unless the vomiting be accompanied with epigastric pain, redness of 
the tongue and thirst, we have no good reason to predicate the existence of 
gastritis. What M. Andral says of the state of the stomach in continued 
fevers is equally applicable to many other cases of less serious importance, 
where the physician is not a little perplexed to determine whether there 
exists a mere" "embarrass gastrique" (in the language of Stoll "saburrcs 



2i6 On the Chemical condition of the Salica, <§<c. [Sept. 

gastriqucs") or a decidedly irrirafive or inflammatory condition of the sto- 
mach. In alluding to the treatment he adds : " unfortunately there must 
always remain some uncertainty as to the actual morbid state of the sto- 
mach in those cases, where the symptoms have been relieved by the use of 
emetics and purgatives : and to add to the difficulty the symptoms which 
have been supposed to indicate the use of such remedies, are by no means 
uniform and constant." The object of M. Donne's Essay is to endeavour 
to remove some of the difficulties, which environ this interesting department 
of Semeiology, and to point out a method by which the physician may be 
enabled to ascertain the various "modifications morbides," in which the 
employment of emetics is or is not appropriate : and first with respect to 
the inflammatory irritation of the stomach, he directs our attention to a 
system hitherto unnoticed by medic al men, and derivable from the chemical 
state of the saliva. Before alluding to the pathological modifications of this 
fluid, it may be useful to glance at the opinions of different authors as to 
its chemical properties in a state of health. 

" M. Magendie regards the saliva as being sometimes acid, sometimes 
neutral, and sometimes strongly alkaline : when the stomach is empty it is 
usually acid ; during mastication it is alkaline, the acidity disappearing 
sometimes "des la premiere bouchee d'alimens." (A tolerably fair speci- 
men of the vagueness of this physiologist's assertions.) 

" According to MM. Tiedemann and Gmelin, the saliva and the mucus of 
of the oesophagus are alkaline in all cases, not only in man, but in every 
other animal, which they have examined. 

" M. Donne's experiments have led him to the same conclusion. He 
has found that the saliva is constantly alkaline before, as well as during ta- 
king food, and also during digestion, provided the stomach is in a healthy 
condition. He assumes it therefore as a position beyond all doubt that the 
normal state of the saliva is decidedly alkaline. Any one may readily sa- 
tisfy himself of its truth by merely moistening with the saliva a slip of litmus 
paper which has been reddened by a weak acid : the blue colour of the dye 
is quickly restored. The saline contents are chiefly lactate and muriate of 
soda, and muriate of ammonia. 

" It is quite true that the saliva will be found not unfrcquently to be acid; 
but this change of chemical property is always coincident, according to our 
author's experience, with a morbid state of the stomach ; and it is on this 
very change of character that M. Donne founds the diagnosis of several dis- 
eases of this organ. He repeats the assertion, that he has never met with 
a single instance of the saliva being acid, when the functions of the stomach 
were healthily performed ; and he assures us that whenever it is so, he has 
always found it to be characteristic of irritation or inflammation of the mu- 
cous coat. 

" Hitherto there have been only two methods by which the existence of 
such a morbid state in doubtful cases has been deducible ; viz. either by 
attention to the effects of the remedies, antiphlogistics or tonics, refrige- 
rants or irritants, sedatives or evacuants, which may have been adminis- 
tered ; or secondly by post mortem examinations. If the axiom "naturam 
morborum ostendit curatio'' be not always rigidly true, it must be admitted 
that its principle has guided, and still guides many excellent physicians, and 
serves as a basis for most of the reasonings which we daily make in appre- 
ciating the value of different therapeutic means. We are willing to admit 
that it is an essentially empirical and often a misleading guide ; but we are 
not to reject its assistance merely from the abuses which some have made 
of it. Medicine is in an especial degree a science of minute observation ; 
and our observations to be practically useful are not to be confined to one 
pet of phenomena to the exclusion of any other. Morbid anatomy acquaints 
us with one set ; semeiology, or the study of symptoms, teaches us another ; 
and therapeia or the doctrine of the action of remedies furnishes us with a 
third. 



1830. 1 On the Chemical condition of the Saliva, <§>c. 217 

"The chemical examination of the secretions during life belongs to the 
second of these great branches of medical science. Hitherto it has been 
too much neglected ; for, with the exception of urinary complaints, there id 
scarcely a class of diseases, in which its assistance has ever been invoked. 

" Without further details, we shall now narrate briefly a few cases which 
will illustrate the good effects of attending to the chemical properties of the 
saliva in disease. 

" It may be necessary to state, that the only testing means, which M. 
Donne recommends, is the use of slips of litmus paper, such as are gene- 
rally employed in examining the urine. Some of them are to be reddened 
by immersion in a weak acid, to serve as tests of alkalinity. 

" The saliva of a man, labouring under intense bronchitis, was uniformly 
found to be acid. On dissection, the mucous membrane of the stomach 
was found " pointillee et ramollie" in some points, and red and highly in- 
jected in others. 

" A young woman, when admitted into La Charite Hopital, was labour- 
ing under a severe attack of bronchitis, attended with great tenderness of 
the abdomen, excessive irritability of the stomach, diarrhoea, ardent thirst, 
&c. The saliva was strongly acid. 

" The disease assumed in its progress a marked typhoid character, the 
tongue was parched and coated with a brown crust ; the abdomen was al- 
ways very tender ; delirium and coma supervened, and the patient died on 
the 10th day after admission. The saliva was acid during the whole course 
of the illness. 

" Dissection. — The mucous coat of tfys duodenum and jejunum was highly 
injected ; the intestinal follicles were enlarged, and many of them ulcerated. 
The stomach exhibited "une injection pointillee" in its large extremity, and 
its mucous coat was soft and easily lacerable in several places : in other 
piaces it was very vascular, and of a dark colour. 

" A young man was received into the La Charite Hopital as a fever pa- 
tient. All the symptoms of ataxic fever soon developed themselves. The 
saliva during the first days was only slightly acid ; but later it became more 
strongly so. He died comatose. The saliva remained acid to the end. 

" Dissection. — The mucous coat of the stomach was healthy in four-fifths 
of its extent ; its large extremity, however, exhibited " une rougeur poin- 
tillee avec ramollissement pulpeuse de cette membrane." 

" In a patient who died of severe pneumonia, complicated with great irri- 
tability of the stomach and with diarrhoea, the saliva had been found to be 
unusually acid, so that it reddened the litmus paper " comme le ferait du 
vinaigre." Besides serious lesions of the thoracic viscera, the inner sur- 
face of the stomach presented in different places a state of high injection, of 
partial softening, and of complete disorganization of the mucous tissue. 

" The preceding cases are intended to illustrate the coincidence between 
a permanently acid state of the saliva and the existence of inflammatory 
irritation of the stomach, as ascertained by dissection. We shall now de- 
tail some„cases, where the saliva was acid at first, but gradually lost its 
acidity and recovered its alkaline properties, as the patients were restored 
to health. 

" A young man was received into the hospital as a fever patient. The 
symptoms were not serious : there was a yellow hue of the skin ; the epi- 
gastrium was rather tender on pressure ; there were however, neither vo- 
miting nor diarrhoea present ; the tongue was white, and the saliva was 
alkaline. During the progress of the case the saliva became acid, conti- 
nued to be so for three days, then became neutral, and as the patient reco- 
vered, gradually assumed its alkalinity. 

" A student of medicine, who had been but scantily fed for several months 
was seized with shivering, pains in the loins, loss of appetite, &c. The epi- 
gastrium was tender on pressure ; the tongue was covered with a thick 
white coating ; the saliva was strongly acid. As the feverish symptoms 



248 On the Chemical condition of the Saliva, <J-c. [Sept. 

subsided, the saliva became neutral, and during convalescence, it recovered 
its alkaline properties. 

" A young woman Was attacked with the symptoms of gastro-enteritis. — 
The saliva was decidedly acid. Antiphlogistic remedies were used with 
happy effects, and the saliva gradually showed itself less and Jess acid, un- 
til it became neutral, and at length normally alkaline. 

"In the case of a young man, who exhibited the symptoms of gastritis, 
viz. great tenderness of the epigastrium, thirst, tongue red and parched, &c. 
the saliva was found to be decidedly acid. By repeated leechings of the 
abdomen, and the use of demulcent and refrigerant drinks, the symptoms 
were speedily relieved, and in a few days the saliva was quite neutral, hav- 
ing no effect either on the simple litmus paper, or on that which had been 
previously reddened by an acid. It soon regained its alkalinity. 

" This patient had two relapses of tiie complaint ; and on both occasions 
the saliva was acid at first, and became neutral and then alkaline, as the 
symptoms disappeared. 

" From the preceding data, M. Donne deduces the important (if verified 
by future enquiries) conclusion, that in all cases of gastric disturbance, where 
the saliva is distinctly acid, we have reason to believe that an inflammatory 
irritation of the stomach is present, and therefore, that an antiphlogistic 
treatment is required. 

" With respect to the converse of the proposition, he candidly admits that 
his facts are not yet sufficiently numerous and definite to warrant him in 
laying down any therapeutic indication ; and he only suggests that, when- 
ever the saliva remains alkaline in gastric complaints, the most appropriate 
remedial means will be found to be emetics and purgatives, He promises 
to continue his own researches, and invites others to follow the same path 
of inquiry." 



1S3G.] On Broussaiism, Expectant plan of Cure, <$-c. <J-c. 240 



Part III.— MONTHLY PERISCOPE. 

Broussaiism. — Dr. Thorburn says " Broussaiism, as it if in 1835, is not 
Broussaiism as it was. It has received from "various sources" a much 
more bearable shape, and seems less exclusively calculated for the meridian 
of Paris. Not that " the only true doctrine" was ever destitute of what the 
critics of the legitimate drama call ' points,' for exclusive of egotistical at- 
tacks on its honorable opponents, as Professor Chomel rather cynically ob- 
served, it has three cardinal points — gastritis, gum-water, and leeches ! — Voi- 
\k, toute la medecine physiologique !" — American Journal, No. 35, May 
1834; ^elSO. 

Expectant plan of cure. — In Mr. Lee's notice of the Hopital des Enfans 
Malades, it is declared that the mortality among the unfortunate children in 
this Institution, is one in four ! The British Reviewers, Forbes & Conolly, 
believe from their own "painful observation, that is rather under than over 
the truth ;" and that "this horrible mortality is to be ascribed, in a great 
measure, to the expectant system of medicine ; to starvation, and gum-water, 
conjoined with the too free use of leeches." — British and Foreign Medical 
Review. 

Sciatica and Rheumatism. — The general system of medical practice in 
Germany, approaches much more nearly to that of England, than in France 
and Italy : bleeding is less frequently had recourse to, but active internal 
medicines are employed, as well as enemata and baths; whilst tisans and 
infusions of herbs are now but little prescribed. 

When speaking of Stutt^ard, Mr. Lee mentions that Sciatica is treated, 
in that Institution, not by blisters applied over the trunk of the Sciatic nerve, 
but below the knee, so as to encircle the leg ; a method which is said to 
produce a speedy cure in most cases. In the general hospital at Prague, 
Rheumatism is treated by the administration of large quantities of warm 
water : both acute and chronic cases appear to be treated in this manner, 
and it is said with success. — British and Foreign Medical Review. 



Clinical Lectures of Sir B. Brodie. — 1. On Epulis* — This disease, ac- 
cording to Sir B. C. Brodie's experience, occurs usually in women ; but he 
has seen it in men. The following is the history of the complaint presented 
us by this excellent practical surgeon. 

" When you look at the disease in its early stage, it appears as if a part 
of the gum were more prominent than the rest ; the prominent part is cov- 
ered by a membrane like the gum, and when cut into, it is not very different 
in appearance from the consistence and structure of the gum itself; at least, 
so far as the eye can discern. On these accounts, as it looks like the gum 
on the surface, as it cuts like the gum, and as it is connected with the gum, 
so it is supposed generally to have its origin in the gum, and 1 cannot say 
that that is not its source in some instances ; but yet I must own that in ca- 
ses which I have had an opportunity of examining, it has appeared to me 
that the disease originated in the alveolar processes. I have observed that 
the disease is always situated by the side of one tooth, and generally a tooth 
is pushed out of the socket as the disease advances. The history of the 
present patient tends to confirm this opinion, for she says that the teeth be- 
came loose and dropped out, and then grew up the tumor. Here is a spe- 

* Lancet, November 21, 1535. 
32 



250 Clinical Lectures of Sir B. Brodie — 1 . On Epulis. [Sept , 

cimen {presenting it) of the disease, attached to the jaw, and in which it 
evidently appeared to have originated in the alveolar process. In the ope- 
ration, I removed with the tumour the portion of the jaw belonging to it ; 
and I found in that part of the jaw which was sawn through, and where it 
was not supposed that any tumour existed, that there was a substance ex- 
actly like the tumour itself, in the alveolar process. I sawed through the 
bone where I thought it was healthy, and there I found the socket of an 
alveolus, in which the structure was so exactly like that of the large tumour, 
that I thought it right to destroy this part. The tumour is at lirst small : 
as it advances the teeth drop out, and the tumour at last extends from one 
side of the jaw to the other. If the disease go on it will ulcerate and in- 
crease in size, and although in this woman it remained stationary, as any 
tumour may, yet it may go on to attain any magnitude. I have seen a tu- 
mour occupy the entire half of the lower jaw, so that the patient could not 
close the mouth ; and it may go on further still, and run the course of any 
malignant tumour. Consider what any malignant tumour of the jaw will 
do, and that is what this tumour also may do. It may occupy the cavity of 
the mouth itself, press upon the cheek, and ultimately produce destruction 
of the face, so that you have a large ill-conditioned ulcer, with a tumour at 
the bottom of it. In short, it may run the course of any malignant disease." 

Sir B. Brodie proceeds to state that although the tumour, if left to itself, 
will ulcerate, slough, and produce destruction of contiguous parts, just as 
scirrhous or fungus hasmatodes, yet it is only so far malignant; for it will not 
contaminate the constitution like those truly malignant disorders. If a scir- 
rhous tumour is removed, the probability is, that another scirrhous tumour 
will appear in the cicatrix, or in some other organ or part. But Epulis is 
one of those half-malignant diseases, which, although not capable of a natu- 
ral cure, and ending in the destruction of the textures with which they are 
immediately involved, do not seem to produce that condition of system which 
gives rise to the formation of similar tumours elsewhere. This is a very 
consolatory fact, and exerts, of course, an important influence on our views 
of treatment. 

If tumours then like Epulis are removed, they do not re-appear. But they 
must be removed entirely. When the tumor is taken away at a late stage r 
the disease does occasionally return. The reason is, not that the disease is 
then more malignant, but the eradication by the operation has not been quite 
complete. The same thing occurs with the tubercles which form on the 
checks of old persons. Remove them early and remove them perfectly, and 
they do not grow again. If removed late, they may not then be removed 
so perfectly, and so under these circumstances they do grow again. The 
following is Sir B. Brodie's method of operating in the instance of Epulis. 

The mode of proceeding must depend on circumstances — on the size of 
the tumour — on its extent — and, partly, on its position. In the greater 
number of cases of this kind that I see — in private practice at least — the 
disease is in the early stage, and, of course, then, the tumor is of small size r 
and may be easily destroyed in the following manner : First of all, all .the 
teeth which seem in any way to interfere with the disease must be drawn. 
This step must be taken before you can do any thing else. You thus expose 
the tumour completely, and then, in ordinary cases, you may proceed in the 
following manner. If the teeth, where the tumour is formed, have been 
dropped out for some time, the alveolar processes have become absorbed ; 
otherwise, of course they remain, and this circumstance you must bear in 
mind. I am now speaking of cases where the tumour is small. I place the 
patient before the light, and then cut off the excrescence, so far as I can get 
at it. If the alveolar processes remain, of course I use such a knife as can 
be carried to the bottom of them ; but if they have been absorbed, a straight 
common knife will do. You then wait for the bleeding to subsidy and if 
there be a great deal of hemorrhage, you may postpone the next step of the 
operation to another day, when it may be done quite as well as on the first 



183G.] Clinical Lectures of Sir. B. Brodie — 1. On Epulis. 251 

occasion. The next step of the operation is to apply the caustic potass to 
the surface of the bone from which the tumor arose. You may apply the 
actual cautery, or nitric acid ; but I prefer the caustic potass, which answers 
the purpose fully as well as the actual cautery, and frightens the patient 
much less. I think, moreover, that you know more exactly how far you go 
with the caustic potass than you do with the actual cautery : and be as- 
sured, also, for I speak from having employed it many times, that it answers 
the purpose perfectly. You should have a piece of caustic potass, with a 
point so as to enter the alveolar process. It should be cut in the shape of a 
pencil, and be a piece of a tolerable length, and it should be fixed, at right 
angles, in the end of a pair of dressing forceps. Do not trust to your hands 
to hold it tight in the forceps, but let it be fastened on by a ligature, passed 
round several timss ; apply it to the surface from which the tumour had been 
removed ; but if the alveolar process remains take care that the caustic pen- 
etrates to the bottom of the process. Many prefer the caustic potass to any 
thing else, because it does not coagulate the blood, and does not prevent the 
caustic from acting, and because also, it will penetrate somewhat into the 
substance of the parts ; whereas the nitric acid coagulates every substance 
with which it comes in contact, and does not sink into it; it is more limited 
in its effects. You may conceive that the caustic potass is very likely to 
run about, to surround the cheek, to burn the tongue, and to injure parts 
beyond those which it is your intention to injure. It will dissolve in saliva, 
In the blood, and in th° urine, and if it were to run about it would produce 
very great evil. How, then, are you to obviate the effects of such an acci- 
dent] Why, just as you always would avoid the effects of its application 
where you do not want it to operate. Whenever you employ it for the de- 
struction of living parts, have something at hand that will act as an antidote 
to it, and stop its operation. If you use caustic potass, you need only have 
some vinegar within reach, with bits of lint to dip into the vinegar and apply 
to the neighbouring texture, If you employ nitric acid, have some carbo- 
nate of potass, or chalk and water, ready to apply to protect neighbouring 
parts. You should never use caustic without having something by you that 
will destroy its properties, when the caustic is in danger of interfering with 
the neighbouring textures. There are some cases in which you apply the 
nitrate of silver (which is not a powerful caustic, and not much used for the 
destruction of parts) to the inside of the eyelids. Always have something 
at hand on such occasions to stop its operation, and the best antidote with 
which I am acquainted, is common oil, which stops its action presently. But 
to return. 

Having removed the part with the knife, apply the potass to the surface, 
by which you will make a slough of the neighbouring parts, and destroy the 
surface of the bones. If the disease has descended to the alveolus, and the 
alveolar process is not absorbed, a narrow pi ce of caustic is to be introduced 
into the bottom of the process. This may be done at the time of excising 
the tumour, if there be not too much hemorrhage ; but if there be, then it is 
better to defer the application to another day : no harm arises from waiting, 
and you never can apply the caustic to much advantage when there is much 
hemorrhage ; that was the reason why 1 only appliedthe caustic slightly to- 
day You should always examine tho part afterwards, in order to ascertain 
if you have left any portion of the tumour undestroyed. If you have, it may 
be removed by a knife, or by the caustic potass, afterwards. It is not often 
necessary, but still, where the comfort or the life of the patient is at stake, 
you should exercise this precaution." 

In cases where bone enters into the composition of the base of the tumor 
Sir B. Brodie employs a pair of bone-nippers, a modification of the common 
stump-bone nippers, but constructed with a double lever by Mr. Weiss. — 
The double lever gives great additional power to the operator. Sir B. Bro- 
die particularly cautions the operator not to leave any disease in the jaw. — 
It may be necessary to remove very large portions, or the whole of it. 



252 <)n Corigreen, or Irish Pearl Moss. [Sept. 

Corigreen, or Irish Pearl Moss. — In the American Journal 
for May, we observe a notice of this article, which is now ex- 
tensively used on the western coast of Ireland, as a dietetic for 
various disorders, especially consumption, dysentery, rickets, 
scrofula, and affections of the kidneys and bladder. It makes a 
fine and digestible jelly, more pure and more agreeable to the 
stomach than many others, by being dissolved in water by boil- 
ing. It is said to agree better with the stomach than animal 
jellies. It is also used in decoction, by boiling Si of it in aiss of 
water, or milk, down to one pint, as a food for children brought 
up by hand, or after weaning, or when laboring under rickety 
or scrofulous affections, and is found highly nutritious, bland and 
easy of digestion. It is said to be without the unpleasant flavor 
of Iceland moss. This article has not become common at the 
south, but we have met with it occasionally, and have been de- 
lighted with it as a dietetic. Indeed, we have found nothing 
which seemed more suitable as aji?^st diet, after gastric or intes- 
tinal irritation, or after great debility, and tympanitic states of 
these important organs. It seemed to fill a place for which we 
had nothing else — being receivable by the stomach before we 
could allow other light articles. We hope apothecaries and 
druggists will enable themselves to supply the article. 

Mr. Bass, Pharmaceutic chemist, directs its preparation for 
medieinal use in the following manner: " Steep 3 ii of the moss 
in cold water for a few minutes, then withdraw it, (shaking the 
water from each sprig,) and boil it in one quart of new or un- 
skimmed milk, until it attains the consistence of warm jelly — 
strain and sweeten it to the taste with white sugar or honey ; 
or if convenient, with candied Eryngo root. If milk disagree 
with the stomach, or be inadmissible in the case, water may be 
used in its stead. The decoction made with milk is recommend- 
ed for breakfast to consumptive patients ; and that prepared with 
water will be found a most agreeable kind of nourishment, taken 
at intervals through the day ; the flavour being varied with le- 
mon juice, or peel, sweet orange juice, cinnamon, or wine of any 
sort most congenial to the palate. The decoction in water, is 
also taken for the relief of cough, at any time in the course of 
the day, when it is troublesome ; and it is, for this purpose sim- 
ply sweetened with honey. 

In dysentery, the decoction, cither in milk or water may be 
administered with equal advantage, and in addition to the sweet- 
ening matter, if a tea-spoonful of tincture of Rhatany be added 
to each cup-full, a tone will thereby be given to the intestines, at 
the same time that nourishment will be conveyed to the system 
and irritation prevented. A large tea-cupfui of the decoction 
may be taken three or four times a day. 

As a pleasant strengthening food, boiled with milk, strained, 
with the addition of a little sugar, it is unrivalled for infants, — 



1836.] Treatment of Mercurial Sail cat Ion, <J-c. §c 25.3 

Delicate persons take it in this way for breakfast, with the hap- 
piest effects." 

Treatment of Mercurial Sal nation by concentrated Muriatic Acid. — M. Vel- 
peau is of opinion, that mercurial salivation is connected with some altera- 
tion of the mucous cryptas in the mouth, and not with inflammation of the 
salivary glands, for he remarks, " when a gland is inflamed it no longer se- 
cretes : besides which, the patients do not refer the pain they feel to the 
glands, but to the interior of the mouth. 

" What is the progress and effects of mercury ! By its extreme subtlety 
it is introduced into the system, saturates it as it were and inflames it ; for 
most generally the gums, the internal lining of the cheeks, the edges of the 
tongue are covered with a thick layer of lymph, and this is most probably 
owing to an irritation, generated by sympathy or continuity, and it is there- 
fore essential to look to the cryptae rather than the glands. This view of the 
subject induced M. Berard to make use of muriatic acid, and myself to em- 
ploy it alternately with a mixture of honey, the acid in question, solution of 
lunar caustic, and several other remedies. For the last two years I have re- 
turned to the use of the acid, but I now prescribe it in the pure or even con- 
centrated state. In a patient who had been labouring under severe ptvalism 
for four days, and to whom I applied the acid by means of a hair brush pen- 
cil, the good effects were immediate. I was afraid, however, lest it should 
produce mischief, but was deceived : a pellicle forms over the mouth, but 
there is no inflammation. Of three patients treated with concentrated mu- 
riatic acid, one has left the hospital : of the two remaining the second recov- 
ered in a few days. In these cases the patients were touched with the rem- 
edy four times in two days, and this sufficed. In the third patient the in- 
flammation was less acute, and the effects less marked : moreover, the sal- 
ivation was of some standing; from all which it may be inferred that the 
muriatic acid is beneficial in proportion to the intensity of the inflammation. 
To this patient, therefore, I applied alum, and the symptoms were almost 
directly ameliorated ; alum, however, to be useful, should be used in sub- 
stance, and in large quantities." — Lancette Francaise, 2nd June. 



Nitrate of Silver for tlie Cure of Chilblains. — Dr. Gamberini recommerds 
the following remedy to prevent the ulceration, and even to disperse chil- 
blains ; they should be moistened with a piece of linen slightly soaked in 
water, so as to keep the skin soft and moist, without being exactly wetted ; 
and when thus prepared, a piece of nitrate of silver is to be rubbed on the 
chilblain ; moderate pressure should be used, and it should be slowly passed 
several times over the part. In a few minutes the epidermis becomes very 
slightly whitened ; at the end of some hours, and generally when the part 
is exposed to the light, as in the chilblains of the hands, the epidermis be- 
comes brownish, and presents a greater consistence to the touch. The ef- 
fect is just the same as that produced on the fingers when a piece of this 
caustic is handled without precaution. A strong pressure, or more pro- 
longed application of the remedy will denude the part; the same thino- will 
happen if the surface be too much wetted before cauterization. But, in gen- 
eral, we may say that when the cauterization is maintained within proper 
limits, it causes no pain, and rarely a slight pricking. 

This simple treatment relieves the patient from all inconvenience, in the 
course of a few days. It may, however, become necessary to re-apply it 
once or twice. — London Medical and Surgical Journal, Feb. 20, 183(5. 



Case of Local Pulsation — By Elisha Bartlelt, M. D. — I was invited, a few 
days since, by Dr. Duesbury, of this town, to see a patient sufferin<r with 
violent throbbing of the temporal arteries. The patient is a chlorotfc giri. 
All that could be ascertained of her previous history, in regard to disease^ 



254 On Flannel in Hot Climates, fyc. fyc. [Sept. 

was that she had been repeatedly bled for what her physicians had called 
brainfcver. At these times, she says, the beating in the temples was pre- 
sent. On examining the temporal arteries, I found them pulsating with a 
very powerful expansive throb, like that of an aneurism. The strength of 
the arterial beats was not uniform. The vessel seemed to swell up under 
the touch, like an artery as large as the little finger, with its circumference 
indistinctly defined. It resembles, somewhat, the swelling out of the tempo- 
ral muscle when the lower jaw is strongly pressed against the upper. Eve- 
ry pulsation was painful, and the action of coughing, although instinctively 
suppressed by the patient, was accompanied by great aggravation of the pain 
in the temples. But the most curious circumstance in this case remains to 
be stated. The pulsations in the temporal arteries were not synchronous with 
those of the heart. The average number of pulsations at the wrist, repeat- 
edly counted, was one hundred and six ; the average number in the temporal 
artery was eighty. The pulse at the wrist was feeble and soft ; the action 
of the carotids corresponded in force and frequency with that of the radials. 
By firmly compressing the temporal artery, low down and anterior to the 
ear, where its action was very much less violent, the powerful throbbing of 
the temples w r as arrested, and the artery flattened away like an aneurism 
emptied in the same manner. I say nothing of the general symptoms, as I 
mention the case to you chiefly as a striking and unequivocal instance of 
pulsation in an artery independent of the action of the heart. — American 
Journal, May, 1836. 



Flannel in Hot Climates. — In the United Service Journal for August, 1835* 
there is a very valuable paper by Dr. Ferguson, on the "Health of Troops," 
which we strongly recommend to our military medical readers — and, indeed, 
to all military men, whether medical or not. 

We were gratified to find our own opinions, respecting the use of flannel 
next the skin in tropical climates, corroborated by a talented army physician. 
Dr. F. observes : "I, for one, protest against it (flannel) as an enervating 
habit, of which the healthy, hardy soldier can never stand in need. To the 
feeble and valetudinary it is most useful ; and, as an hospital indulgence, 
highly proper ; but, when worn in the crowded barrack-room, with, too of- 
ten, bad washing and insufficient change, it becomes a deposit of filth— even 
of contagion, irritating to the skin, and incompatible with health and clean- 
liness." Dr. F. very properly makes some exception, such as in bivouacs, 
and when the soldier is encamped, and in a rigorous climate. " With the 
above exceptions, it should never be seen either in the barracks or quar- 
ters." — Medico- Chirurgical Review. 



On the different offices of Lacteals, Lymphatics and Veins in the Function of 
AhsorptionS — Dr. Handyside, of Edinburgh, presented to the Medical Section 
of the British Association, at the Dublin meeting, an interesting paper on 
this subject, in which, after starting with the proposition, now generally 
admitted, that these three set of vessels are one and all of them endowed 
with the faculty of absorption, he proceeds to lay down, as a general posi- 
tion, that each of these three systems of vessels is endowed with a peculiar 
office in the general function of absorption : 

1st. That the lacteals absorb aliment, and refuse entrance to all other 
matters. 

2nd. That the lymphatics remove the elements of the body which have 
become useless or noxious, to make room for the deposition of new matter. 

3d. That the veins, besides returning the blood to the heart, absorb vari- 
ous foreign matters. 

1st. Function of Lacteals. — This appears to be decidedly to convey nutri- 
ment into the system, and that no other class of vessels can exercise that 
function, would appear almost proved to demonstration by the experiments 



1836.] Treatment of Itch, Sulphuret of Potash in Asthma. 255 

of Dupuytren, in which it was ascertained, that by applying ligatures round 
the thoracic duct of horses, death from inanition followed in all instances. 

2nd. Function of Lymphatics. — Closely as the lymphatic system resem- 
bles the lacteal, even in the most minute details of anatomical characters, 
the vessels composing it nevertheless appear to have for their peculiar func- 
tion the office of removing the debris of the body. After noticing the argu- 
ments of Dr. Hunter and Mr. Hewson as to this function being performed 
by the lymphatics, Dr. II. ingeniously observed, that in vegetables, the de- 
bris, instead of being removed by vessels, are detached from their surface, 
as in the falling off of their leaves and the scaling off of their bark, or they 
are piled up in the interior of the individual, (as heart wood,) and preserved 
during the whole period of its existence ; which circumstance, taken in con- 
nexion with the absence of a system of vessels in vegetables corresponding 
to lymphatics, may be regarded as affording a negative proof in support of 
the opinion here stated. 

Dr. H. next alludes to the supposed communication between the veins and 
lymphatics, which he maintains does not exist except where great lymphat- 
ic trunks empty themselves into the venous system ; thus showing an inde- 
pendent existence of the lacteal system, which argues in favour of their ha- 
ving to perform a separate function. 

3d. Absorption by Veins. — Several experiments were detailed, proving 
that the absorption of fluids from the surfaces of serous and mucous mem- 
branes, and from the surface of the skin, was accomplished by the veins and 
not by any other vessels. These experiments consisted in the exposure of 
fluids containing ferro-cyanate of potass and prussiate of potass to the serous 
and mucous surfaces, and to the skin stripped of its cuticle. Absorption of 
the fluids so applied took place, and by the application of suitable tests, the 
sulphate and deuto-sulphate of iron, the presence of the salts above men- 
tioned was discovered in the blood, but never in the fluid contained in the 
thoracic duct. 

The results of these experiments were similar to those of Flandrin, Tie- 
demann and Gmelin, and Magendie, and prove that absorption from the sur- 
faces of the various organs is affected by the veins. — American from Dublin 
Journal. 



Treatment of Itch. — Dr. Lison, physician to the hospital of Donzi, lauds, 
in a communication in the Journal Gen. de Therapeulique, the efficacy of 
the following ointment for the cure of Itch. 

Rs. Litharge ^ 1. 

Olive Oil, % iv. Mix, place over a moderate fire, and stir until the li- 
tharge is well dissolved, and the ointment acquires a slight blackish tint. 

Half an ounce is to be used in friction to the hands, feet and armpits, 
morning and night. — American Journal. 

Sulphuret of Potash in Asthma. — An individual, labouring under a severe 
attack of spasmodic Asthma, applied to Dr. Carusi, who having ordered the 
Aqua Lauro-cerasi internally, and frictions with tartar emetic ointment, 
without success, directed 16 grains of the sulphuret of potash, rubbed into 
a paste with honey. This quantity was divided into four portions, one of 
which was given three times a day. After the administration of the last 
dose, the Asthma entirely disappeared, and the cure was complete. — Amer- 
ican Journal. — London Medical and Surgical Journal. 

Sulphate of Quinia and Lactucarium in Cholera. — Dr. Hal- 
phen of New Orleans, in a memoir on Cholera Morbus compli- 
cated with Yellow Fever, as it appeared in New Orleans, during 
the epidemic of 1832, seems to prove by a number of cases and 



256 On Phloridzine ; a new organic substance, §c. [Sept. 

observations, that the epidemical constitution predisposing to 
Yellow Fever, is overruled by that of Cholera. He found that 
the disease would supervene on cases of Yellow Fever, the 
symptoms of which would meliorate immediately on the occur- 
rence of Cholera. He also observed, that strangers in a yellow 
fever region failed to take this disease, as they were otherwise 
wont to do, if Cholera prevailed ; and that, when its attacks were 
suffered, they were much more benign than under other circum- 
stances, they were with unclimatized citizens: His observations 
were made in New Orleans during the years 1832, '33 and '34. 

" The remedy upon which Dr. H. chiefly depended for the cure of Chole- 
ra, in the cases which fell under his care, was Sulphate of Quinia combined 
with Lactucarium : and the facts which he has adduced, would all certainly 
appear to prove it superior in efficacy to all other remedies that have been 
proposed for this disease. It was administered either in pills, composed each 
of three or four grains of Sulphate of Quinia and half a grain of Lactucari- 
um ; and administered every five, ten, fifteen or twenty minutes, until reac- 
tion took place ; or forty grains of sulphate of Quinia and from six to ten 
grains of Lactucarium, were dissolved in six ounces of fluid, of which a spoon- 
ful was given at intervals more or less short, according to the circumstances 
of the case. Six to twelve grains of Sulphate of Quinia and from two to 
four of the Lactucarium, in a pint of mucilage, were also injected per anum 
every fifteen minutes, until the diarrhoea was suspended. Sinapisms and 
stimulating liniments, to the surface, were at the same time frequently em- 
ployed. 

" By this plan of treatment, we are assured by M. Halphen, that a general, 
moderate, and regular reaction was almost invariably established, and the 
speedy convalescence of the patient ensued '' — American Journal. 

Phloridzine; a new organic substance. (L'Institut. No. 143.) This veg- 
etable principle was obtained by MM. de Koninck and Stas from the bark of 
the root of the apple, pear and cherry trees. It may be procured by boiling 
the roots for four or five hours in water, decanting the liquid and continuing 
the ebullition with an addition of pure water for two hours, and again decant- 
ing. The decanted liquid, in each instance, after twenty-four or thirty-six 
hours repose, will deposite small crystals of a more or less brown color. It 
may also be obtained from an alcoholic solution. 

Phloridzine is but slightly soluble in cold water, but more so in warm. At 
188 ° C. it is dissolved in every proportion. It is more soluble in cold alco- 
hol than cold water, but equally in the two liquids at their boiling tempera- 
ture. Heated above 100 ° C. it slowly melts, at 177 ° boils, and at 107 ° is 
decomposed, producing benzoic acid which sublimes. It is decomposed by 
the sulphuric, nitric and hydrochloric acids. Ammonia and the other caus- 
tic alkalies in solution dissolve it without alteration. The deutosulphate of 
iron colors the solution of phloridzine a deep brown, causing at the same time 
an ochre-yellow precipitate ; no change in the color is effected by the pro- 
tosulphate. Its composition is carbon 14, oxygen 9, and hydrogen 18 atoms. 

The author, M. de Koninck, suggests in his memoirs, that phloridzine may 
be ranked with the most valuable febrifuges and will rival in utility the sul- 
phate of quinine. 

CORRECTION— \n the notice of tho medical properties of (he Amygdalus Persiea, 
on the 149lh page, 1st Volume, of this Journal, it is stated on the authority of Professor 
Dugas, Ih'it under its use "the disease / per!. issis) generally lisappenred within four or 
five days." Dr. D. does not wish to have heen understood precisely in this way ; but 
that, the disease generally disappeared within about half the usual time; all the symp- 
toms being mitigited forthwith. 



SOUTHERN MEDICAL 

AND 

SURGICAL JOURNAL 

Vol. L] OCTOBER, 1836. [No. 5. 

Part I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

A Letter to the Editors. By Edward Delony, M. D. of Tal- 

botton, Georgia. 

Gentlemen, — I was much gratified to see the announcement of 
the Southern Medical and Surgical Journal having commenced 
its career in the medical world — long, long may it prosper. The 
benefits which will result from it, to the profession of the South, 
will be felt and acknowledged for years to come, it must be sus- 
tained, and I confidently believe, that the highminded liberality 
of Southern medical gentlemen will sustain it. 

I propose, in a plain and brief manner, to advance a few rea- 
sons to shew the necessity and importance of a Southern medi- 
cal periodical. When we take into view the various influence 
of climate, especially on the human constitution, even in the lim- 
its of the United States, and the consequent variation and pecu- 
liarity of symptoms which characterize disease, brought about 
by this powerful agency, in connexion with other local causes, 
over which it operates, we do not hesitate to declare our firm be- 
lief, that a successful course of treatment for almost any disease, 
in the northern part of the American continent, or even the U- 
nited States, would in the State of Georgia, Alabama, or Louisi- 
ana, in the same disease, not only prove unsuccessful, but, in all 
probability, dangerous to the life of the patient. 
33 



258 A Letter to the Editors. [October. 

In order to bring to your view a striking example of the influ- 
ence of climate, with other local agents, in propagating diseases 
peculiar to itself, I would cite you to the history of that most 
frightful scourge, Asiatic Cholera. When and on what part of 
this continent, has this disease ever penetrated into the pure and 
healthy climate of the highlands, or among the hardy yeomanry 
of the country, distant from the moist atmosphere of the coasts, 
or large rivers, and low flat countries commonly covered with 
water one half of the year ? I think no instance of the kind can 
be pointed out, our recollection does not serve us as to a single 
one, at least in the United States. 

Again, in a case of common Pleurisy, arising in a northern 
climate, do we discover no difference in the treatment of a simi- 
lar case, arising in the south ? . In the former case, free blood 
letting, a few saline cathartics and a good sweat, would proba- 
bly be sufficient to cure the patient. But is this all we have to 
do in the south? No. We would have barely commenced. — 
Here, we find a complication of symptoms, altogether out of the 
ordinary routine of a common attack of pleurisy. We have an 
inordinate excitement in the liver to control, in consequence of 
which an obstinate continued fever prevails, and the pain in the 
side remains unsubdued, although we have bled our patient as 
much as we dare to do ; extensive blistering has now to be re- 
sorted to, and the patient almost exhausted, has frequently to be 
supported with stimulants ; the harrassing and painful cough, is 
frequently, most frightfully aggravated, in consequence of an 
enlargement of the liver — in short, with all the symptoms of a 
Pleurisy, we have combined, those of a violent bilious fever. 
And where now shall we look for correct information in the man- 
agement of such a case? surely not to the pages of a northern 
periodical or amongst the writings of northern physicians? 

So also in Rheumatism, a physician, when this disease occurs in 
a cold climate, will merely, by bleeding and sweating his patient, 
often effect a cure ; while a southern practitioner will find two- 
thirds of his cases of Rheumatism, connected with and dependent 
on a diseased condition of the liver, with an additional variety of 
symptoms. Will the same treatment answer in both cases? — 
common sense would teach us otherwise, and yet the treatment 
for this disease is laid down in the books, the same, whether it 
occurs in Georgia or in Maine, whether it is dependant on a 



1830.] A Letter to the Editors. 259 

morbid action of the liver, or from other causes. I have cured a 
patient of a violent attack of Rheumatism, by directing my rem- 
edies entirely to the correction of a highly diseased liver. 

So also in Typhus Fever — where is the physician in Georgia 
who has seen a well marked case of Typhus Fever, according 
with the symptoms as laid down by northern writers ? It is very 
true, we have typhoid diseases — some years our summer and 
fall diseases are ushered in and wear throughout the garb of 
a typhoid epidemic; whilst other years, they are of a highly in- 
flammatory grade. Again I would ask, amidst all this variety 
and peculiarity of disease, where shall we look for the correct 
treatment, but among that portion of the faculty where they occur? 

I might increase this part of my communication to an almost 
interminable length, even without going into the minutiae of the 
subject ; but under this head, I have adduced sufficient reason, I 
think, to satisfy every one, that among ourselves we must look 
for the most proper, correct and successful treatment of those 
diseases which prevail among us. The experience and talents of 
the profession of the south, will compare with that of any other 
portion of the world, and their judgment is as sound and correct, 
although they are not in the habit of entering into those fine spun, 
refined theories, that would lead them to the administration of a 
thousandth part of a grain or drop, with the least confidence in 
its producing any impression on the most susceptible organ in 
the human system. 

The profession at the south are too much in the habit of looking 
to the north for medical light and knowledge, and what does it 
profit them after they obtain it — they find after all their trouble 
and expense, they have to avail themselves of their own resour- 
ces ; their own judgment and experience soon teach them the 
fallacy of suffering themselves to be governed and guided by the 
views and opinions of those, who can know nothing of the diffi- 
culties which we have to encounter in the management of the 
diseases which occur among us. Then, let us come freely 
forward, as we have now a medium through which we 
may kindly interchange our ideas, and present to each other our 
experience. I trust for the honor of our profession and for the 
benefit of mankind, we will not neglect so favorable an opportu- 
nity for the improvement of medicine, and the mitigation of the 
sufferings of our fellow creatures. 



260 A Letter to the Editors. [October. 

There are other strong reasons why it is important that a 
southern medical periodical should be published among us. The 
prevailing attempt that is now making to introduce among the 
credulous and superstitious part of the community, a " system of 
practice? which must tend more to the destruction of human life, 
than the sword or the bottle — is well calculated to arouse the 
philanthropic feelings of every physician, and arm him with re- 
newed zeal in the dissemination of those true and correct princi- 
ples of medicine, which must and will speedily overwhelm, with 
shame and disgrace, so daring and disgusting an attempt to im- 
pose on the human family what can be considered, in no other 
light than an organized system of murder. 

Humanity weeps at the many instances of suffering and death 
which almost daily occur, brought about by the ignorant and 
imprudent administration of Lobelia, or by the still more barbar- 
ous process of stewing or boiling human beings alive ; and will 
the medical profession look silently on, and make no efforts to 
rescue their fellow creatures from the death-like grasp of such 
bold and reckless imposture, or break the fatal spell that seems 
to have seized upon them ? 

The medical profession desire not to keep the people igno- 
rant of the principles of medicine, on the contrary, they would 
fain give them all the information in their power. They would 
rejoice that every household could be possessed of the true prin- 
ciples and knowledge of the healing art — and how shall this desir- 
able end be obtained? — Let every farmer subscribe for a medi- 
cal work, he will find it but a small tax, and of incalculable ben- 
efit. Why should the circulation of medical periodicals be con- 
fined alone to the medical profession ? much urcful information 
can be gained from them even by the most ordinary capacities. 
We would beg leave then to suggest to the people of the South, 
the great propriety of liberally encouraging the " Southern Med- 
ical and Surgical Journal," — it is a work published among you 
by your own people, and is deserving your encouragement. It 
is a work, in which every farmer may at once find the experi- 
ence of the ablest physicians of the south, in the diseases which 
daily occur around him. It is truly a southern work, in which 
every southern man ought to take a deep interest. 

In conclusion, I would respectfully suggest to every physician 
who may be a subscriber to this journal, and all others who feel 



1836.] Surgical Cases. 201 

a desire to encourage southern enterprise of this kind, to use his 
exertions in procuring subscribers, it will be a noble duty, and 
he will be contributing a lasting benefit to his neighborhood, and 
the people at large, by increasing those means which must give 
a foundation and circulation to the work, commensurate with 
the improvement of the arts and sciences, and as lasting and du- 
rable as truth. 

EDWARD DELONY. 
Talbotton, Ga., August, 1836, 



Surgical Cases. By Paul F. Eve, M. D., Professor of Surgery 
in the Medical College of Georgia. 

SERIES NO I. 

Case 1st. — Amputation of the Thigh — Scrofula — Operation 
successful. ^, 

This was an old aggravated case of Scrofula. The patient 
was a negro woman, about 38 years of age, who had borne chil- 
dren ; but who for several years had been so afflictdd as to be 
unable even to wait upon herself. The disease had apparently 
affected the whole constitution. She had ulcers on several parts 
of her body, but more particularly on the left foot and leg. In 
fact, the whole ankle-joint and foot of that side formed one im- 
mense ulceration, from the surface of which there was periodical 
(I cannot say regular) hemorrhages. The patient had been sub- 
jected to a variety of treatment, while under the care of the late 
Dr. Anderson Watkins of this city. For the last ten or twelve 
months, the case being considered incurable, this woman was 
allowed to place herself in any position, and at the time of the 
operation the left leg was permanently flexed upon the thigh. 

At her own suggestion, an operation was agreed upon, the ob- 
ject of which was to prolong her life, now endangered by the 



2G2 Surgical Cases. [October. 

repeated copious bleedings from the large ulcer about the left 
ankle, and by removing an useless limb to relieve her sufferings, 
&c. On the 5th of August, 1828, the circular flap amputation 
of the left thigh was performed, which the patient bore remark- 
ably well, both morally and physically. The muscles were 
pale, flabby and cedematous ; so that the skin reserved for cov- 
ering the stump was found to be too long, and a portion conse- 
quently was removed ; the bone was a mere osseous shell, offer- 
ing very little resistance to the saw ; and the principal artery 
was so altered that when tied, the internal and middle coats ad- 
hered to the forceps, and were brought away as a plug out of 
its calibre. The stump was dressed in the usual manner of the 
day, and afterwards with fine powdered charcoal, under which 
application it healed in about 30 days. It never re-opened, 
though the patient still had ulcers on other parts of her body. — 
She lived nearly two years after the amputation, and it is said 
died of colic. In all, she was afflicted 19 years. 

Case 2nd. — Amputation of the Arm — Ulceration of a portion 
of the flap, from pressure upon the bone by the adhesive strips. 

This occurred in one of the wounded at the battle of Ostro- 
lenka, during the revolution of Poland in 1831. Amputation of 
the right arm was performed in June, in one of the military Hos- 
pitals of Warsaw, and Dr. Placer, chief surgeon, assisted and 
applied the adhesive plaster. The strips were placed accu- 
rately over the stump, but drawn so tight and with so much 
force, that at the next dressing a portion of the skin which came 
in contact with the circumference and sharp edge of the bone, 
had sloughed. This of course retarded the healing of the wound 
for several days, though the bone did not protrude. 

Remarks. — As it is an axiom in Surgery, that skin and not 
muscle is the proper covering for a stump, the inconvenience 
above alluded to might have been avoided, either by using only 
the necessary degree of pressure in applying the dressings, or 
probably by rasping or paring the rough edge of the bone, before 
laying down the flaps. This case also exhibits the importance 
of each Surgeon attending to his own dressings : but acting as 
I was then, under a superior officer, submission was proper. 



1830.] Surgical Cases. 263 

Case 3rd. Protrusion of the Bone after Amputation of the 
Thigh. 

This was also one of the unfortunate wounded at the battle of 
Ostrolenka, and though placed under my care, the operation had 
been performed by another, and whose apology for the nature 
of the stump, was that he had been compelled to perform it at 
night and without proper assistance. This may be regarded a 
case of peculiar interest; one at least of rare occurrenee in the 
present enlightened state of Surgery. It had been upwards of 
30 days since the operation, when I first saw it. The soft parts 
adhered intimately to the bone, and the stump was conical or of 
the sugar loaf shape. The extremity of the femur projected 
about an inch and a quarter beyond the skin. Its periosteum 
was destroyed, and a line of separation was well marked just 
beyond the point embraced by the soft parts. The protruding 
bone seemed to be in a fair way of being removed by the ab- 
sorbents, when by a change of situation, I lost sight of the case. 
But no doubt the separation was completed. 

Remarks. — Granting the circumstances under which this ope- 
ration was performed, (during the night and without proper as- 
sistance,) were a satisfactory excuse for the protrusion of the 
bone, ought not the projecting portion to have been removed the 
next day ? The muscles might have been easily dissected up, 
the bone sawed off higher up, and then properly covered by the 
skin. The absorbents were truly sufficient for the separation, 
but besides the difference of time between them and the saw in 
effecting the same object, which is as three or four months, to fif- 
teen or twenty seeonds, and in the pain, &c. ; it is well known 
that to a sugar loaf or conical stump, an artificial leg cannot be 
applied and worn with comfort by the unfortunate sufferer who 
loses a limb. 

Case 4th. — Amputation of the Leg — Reunion on the third 
day. 

This operation was performed upon a healthy soldier, in the 
barracks near Warsaw, in July, 1831, who had received a mus- 
ket ball through the right ankle joint, which was succeeded by 
necrosis of its bones. The skin exactly met over the face of 



264 Surgical Cases. [October. 

the stump, and many circumstances conspired to favour reunion 
of the soft parts by the first intention. It being mid-summer, 
the dressings were removed on the third day, and upon exami- 
nation the opposite edges or lips of the wound were agglutinated 
together, the whole line, except where the ligatures came out. 
This case also passed from under my care by a change in the 
army. But I do not pretend to present it as a case of perfect 
union after amputation — the ligatures undoubtedly produced 
some suppuration. 

Case 5th. — Amputation of both Legs below the knee — Patient 
in the street on the fourteenth day after the operation. 

In an article on the subject of the chlorides of lime and soda, 
published in a late number of the American Journal of the Med- 
ical Sciences, Philadelphia, this case was alluded to. The pa- 
tient was a negro boy,* about fifteen years old, who had his 
feet destroyed by gangrene, the effects of frost-bite. Amputa- 
tion was performed at the usual place below the knee of both 
legs, on the 30th of January, 1834. The stumps were dressed 
on the eighth day ; on the morning of the 10th after the opera- 
tion, the patient rode in a buggy several squares of our city, and 
on the fourteenth day, he went into the streets of his own accord. 
This at least equals Sir Charles Bell's case of amputation of the 
arm, in which the patient was able to go into the streets of Lon- 
don, the 7th day after the operation. 

Case 6th. — Amputation of the Fore- Arm — But two dressings. 

In April last, 1836, a little girl had her right hand terribly shat- 
tered by the bursting of a powder-flask, which she had opened 
over some live coals on the hearth. The thumb was entirely 
torn off and thrown out at the top of the chimney, into the 
the yard. Amputation was performed near the wrist, and the 
stump healed so kindly, that it was dressed but twice with ad- 
hesive strips, the ligatures ofFeringthe only obstacle to complete 
reunion. 

Augusta, August, 1836. 

* This boy now belongs to Mr. Houslcy, where he has been learning sad- 
dlery for the past six months, and in losing his feet and legs has certainly 
lost nothing to disqualify him for the acquisition of a valuable trade. 



1830.] Remarks on, Idiopathic Mortification. 265 



Remarks on the Pathology of Idiopathic or Spontaneous Morti- 
fication ; with cases. By L. A. Dugas, M. D., Professor of 
Anatomy, &c, in the Medical College of Georgia. 

That the true Pathology of Idiopathic or Spontaneous Gan- 
grene is hut imperfectly understood, may justly be inferred from 
the various and vague views emitted by writers on the subject. 
Most of them, confining themselves to the consideration of its re- 
mote causes, have enumerated old age, the use of unsound wheat, 
or ergot, and several morbid conditions of the system, as scro- 
fula, syphilis, infection, &c ; whilst but few have studiously 
observed the organs of innervation and nutrition, in the affected 
locality. It is true that ossification of the arteries of the extrem- 
ities has been assigned as a probable cause of some cases of gan- 
grene of the fingers and toes, but I am not aware that the nerves 
and lymphatics have ever been minutely examined in such ca- 
ses. 

If the functions of innervation and nutrition, in general, be im- 
paired, every part of the system should simultaneously suffer, 
and simultaneously cease to live, if the impairment be sufficient- 
ly great. But it is difficult to understand how such a general 
disorder can be exclusively evinced in a special locality. To 
admit that putrifying fluids, or deleterious agents, are forced by 
the vis medicatrix to a certain point, and permitted to wreak de- 
struction where it can be borne with least injury, (usually in the 
extremities,) appears preposterous. By what agency can the 
offending matter be collected from all parts of the circulating 
medium, and accumulated in a finger or toe ? We know that 
no part of the body, can retain life without nervous influence and 
nutrition, and, consequently, that the loss of either must necessa- 
rily induce death of the part. Moreover, we know of no inter- 
nal cause by which local mortification can be produced, unless 
the hypothesis just rejected be admitted. 

That the condition of the general system may have some in- 
fluence in the development of gangrene, in parts already dis- 
posed to it, I do not deny. Such a degree of arterial ossifica- 
tion, or of local compression, for example, as would present but 
a slight obstruction to the circulation in a young, strong and ro- 
34 



2G6 Remarks on Idiopathic Mortification. [OcV 

bust individual, would prove ample cause of mortification in one 
whose general energies were much impaired, either by age or 
disease. Such cases too are the most unmanageable, for the ill 
condition which permits the origin of mortification is rapidly 
aggravated by the very existence of the putrescent locality. 

We are now speaking of that kind of mortification which oc- 
curs with little or no previous inflammation; but in what res- 
pects does this differ from that preceded by a high degree of in- 
flammation? In inflammation, are not the vessels diseased? 
Is not nutrition impaired? — And may not the effusion of lymph 
in the cellular tissue, produce such a compression of the nerves 
and vessels as to affect innervation as well as circulation ? Car- 
ry these phenomena of inflammation beyond a certain limit, and 
gangrene will be the result — gangrene from excessive inflam- 
mation. 

Our knowledge of capillary action, as well as of innervation, 
is extremely limited ; yet these are the operations we should 
study, in order to scan the mysteries of inflammation, and avoid 
the dangers of gangrene. Let us confine our investigations to 
the condition of the circulatory vessels and nerves, and I hesitate 
not to predict that the pathology of Idiopathic Mortification will 
very soon be properly understood. It is of the utmost practi- 
cal importance — that it should be determined whether this disease 
depends on a constitutional, or a local defect ; for the treatment 
entirely depends on the decision. If the disease, or rather death, 
be of local origin, the sooner its scat is severed from the body, 
the greater will be the promise of recovery, since the system 
confessedly suffers exceedingly by the presence of a mortified 
member ; whether by absorption of noxious particles or not, I 
will not discuss. If, on the other hand, gangrene recognizes a 
constitutional cause, we have nothing to gain from local appli- 
cations, but must direct all our efforts to the regeneration of the 
impure fluids. 

These reflections were suggested by a case I attended, in con- 
junction with several distinguished practitioners, and the treat- 
ment, of which proved extremely embarrassing, from our imper- 
fect knowledge of its pathology. I will subjoin a brief history 
of it. 

Mr. •* *, about 45 years of age, of a strong, robust constitution, 
though rather corpulent, perceived about the 1st of March, on 



183G.] Remarks on Idiopathic Mortification. 267 

the dorsum of tho toe next to the little one, a small reddish spot, 
attended with very slight sensitiveness, and which occurred with- 
out appreciable cause. Referring it to the pressure of his boot, 
he paid but little attention to it, and merely wore an easier shoe 
for a few days, when he accidentally observed that the spot had 
spread over the toe, and assumed a dark hue. He immediately 
called in his physician — the toe was dead. It was removed 
with very little pain, and the mortification was found to have ex- 
tended above and beneath the metatarsal bone sustaining the toe, 
and to furnish a sanious discharge through fistulous openings at 
the distal extremity of this bone. The disease now seemed to 
subside ; the place of amputation healed kindly ; but the dis- 
charge continued. A few weeks after, the integuments over 
and beneath the metatarsus, gradually became oedematous, and 
of a deep red, and this extended to the toe next to the great, 
which died six weeks after the first. I was now called to see 
him, and found his countenance very much altered and anxious ; 
he was very nervous and desponding ; pulse small and frequent, 
(120) ; corpulency much diminished ; but no functional derange- 
ment; little or no pain in the affected foot. The case had been 
treated, locally, by poultices, and generally, by various prepara^ 
tions of sarsaparilla, mercury to ptyalism, and low diet. There 
never had been any fever. The body, especially the affected 
limb, has presented small greenish patches, referred by the at- 
tending physician to remains of syphilis, which the patient had 
some 12 or 15 years previous. It was then treated by nitric 
acid ; subsequently appeared in the throat, skin and tibia ; was 
again removed, by mercurials and diet drink. He has had no 
symptom of it since. 

We now determined to apply leeches, and to make free inci- 
sions through the skin and cellular tissue. From twenty to thir- 
ty leeches were applied five or six days with only apparent ben- 
efit ; the incisions were made wherever the disease seemed dis- 
posed to extend, and the cellular tissue was invariably found 
dead, although the skin scarcely presented signs of inflammation. 
The regimen was made generous ; diet drink continued a short 
time, then substituted by porter and bark ; poultices to the foot. 

The disease, however, gradually increased, so that by the first 
week of May, the oedema had gained the ankle, and some signs 
of it were perceptible in the gastroencmii. All the soft parts 



268 Remarks on Idiopathic Mortification. [Oct. 

beneath the metatarsus, and some above it, were in a state of 
gangrene ; all the toes were dead, with the exception of a part 
of the great toe ; some difficulty in voiding urine ; frequently 
restless at night, and requires opiates ; general energies very 
gradually failing. Two more physicians were called in consul- 
tation on the 7th May, when amputation was proposed, but de- 
ferred in order to give another trial to a free mercurial course, 
in hopes of correcting the constitutional malady. The foot and 
leg were rubbed and covered with unguent; hydrarg; and large 
doses of calomel administered internally ; the Bark and Porter 
continued. 

May 12th. Gums slightly touched ; an incision a little above 
the inner ankle gave issue to nearly a half-pint of pus, which is 
discharged by pressure of any part of the leg, up to within four 
inches of the knee ; leg very cedematous and somewhat sensitive 
on pressure. Calomel discontinued ; costiveness removed by a 
small dose of sulphate of magnesia. 

16th. (Edema increasing ; discharge very abundant ; nausea 
and diarrhoea ever since taking the aperient ; no appetite ; rejects 
the bark and porter ; has fever occasionally ; opiates. 

17th. Stomach and bowels much relieved; some appetite; pu- 
rulent discharge half-pint per diem ; — Consultation again called, 
and amputation recommended, as the only resource left. I accor- 
dingly removed the limb above the knee, on the next day. The 
operation was borne with unusual fortitude ; the femoral artery 
was found, on taking it up, to be partially ossified ; the stump 
w r as dressed in the usual manner, with adhesive strips, &c. — 
The patient felt much relieved and cheerful for several days ; 
when nausea and diarrhoea returned, with more or less fever dai- 
ly, and were subsequently attended with copious clammy sweats, 
sleepless nights, vomiting, hiccough, and gradual sinking of the 
pulse. Death ensued on the fifteenth day after the operation. 
The stump never evinced the slightest disposition to heal ; but 
discharged a great quantity of brown, putrescent matter, and 
finally assumed the gangrenous aspect throughout nearly its en- 
tire surface. On examination of the amputated limb, the artery 
was found ossified down to its division; the posterior tibial was 
also ossified in its whole length, and formed at the malleolus a 
complete bony cylinder. The other branches were not traced; 
the dorsal artery did not exist. 



183G.] Remarks on Idiopathic Mortification. 209 

The questions which present themselves, in the consideration 
of the above case, are — 1st. What was the immediate cause of 
the disease. 2nd. If constitutional, could life have been saved ? 
3d. If merely local, could life have been saved. To the 1st query, 
I would answer that sufficient cause is to be found in the ossifi- 
cation of the arteries, which, being also very much thickened, 
manifestly impeded the circulation. The individual was, more- 
over, in the enjoyment of excellent health at the time the disease 
manifested itself; was a man of steady habits, and one who led an 
active life. His general health became impaired only after his 
mode of living had been changed, his system subjected to the 
action of medicine, and, above all, to the destructive influence of 
a gangrenous member. In reply to the second question, I have 
already adduced some reasons for doubting very much that a 
condition of the system so depraved as to cause the spontaneous 
death of any part of the body, can, by any means in our power, 
ever be corrected with sufficient promptness and effect, to arrest 
the progress of mortification, or to heal the wound made by am- 
putation. In answering the last inquiry, I must observe that in 
the case before us, the ossification existed, not only in the foot, 
but also in the thigh, and indeed partially in the radial artery of 
the same side, so that, although the cause of the mortification 
was to a certain extent local, it could not be entirely removed 
by amputation — the only remedy. Suspecting ossification to be 
the cause of the disease, I early endeavored to satisfy myself on 
the subject, by feeling for the vessels about the foot and leg. I 
could never perceive any pulsation, but the oedematous state of 
the parts prevented me from considering the absence of this sign, 
sufficient evidence of ossification. The continuation of the an- 
terior tibial, it has already been stated, did not exist on the tar- 
sus. In this case there was manifestly a lesion of the organs of 
nutrition in the whole limb. — It was inevitably fatal. 

The following extract from my note-book, will furnish Du- 
puytren's views on the cause of Gangrena Senilis, illustrated by 
specimens of morbid anatomy. 

" Mr. D. exhibits to the class, portions of the arterial system of a man who 
died at the 69th year of his age, of Gangrene of the toes. He takes occa- 
sion to state, that in his opinion, the cause of Gangrena Senilis is not old 
age, but essentially an affection of the arteries leading to the parts diseased. 
This lesion is generally ossification, attended with thickening of the coats 
of the vessels and redness of their internal membrane. The case under ex- 



270 Remarks on Idiopathic Mortification. [Oct. 

amination fully demonstrates the correctness of this explanation ; for the 
crural artery presents particles of ossification, some degree of hypertrophy, 
redness of the inner coat, and an obstruction formed by a bloody concretion. 
This coatrulum is, however, very different from what is occasionally found 
in healthy vessels ; in these, the obstruction is not complete, but formed by 
a cylindrical mass of fibrine, the diameter of which is smaller than that of the 
artery ; the mass causing the obstruction in cases of inflammation of the 
vessel, is very different from fibrine, resembles burnt currant jelly, is of the 
same consistence throughout, and fills completely the caliber of the artery, 
being adherent to its inner surface. When scraped off, this surface is found 
quite red, and the coats thickened. These lesions increased as the exami- 
nation was carried nearer the extremity of the vessels or near the foot. — 
There were in some parts ulcerations of the inner coat. The arteries of the 
other leg were perfectly healthy. Mr. D. is willing to admit, that the de- 
bilitated state of the constitution, brought on by old age, may favor the ossi- 
fication, and this ossification cause the inflammation and consequent obliter- 
ation ; but contends that these effects might be produced independently of 
old age." 

M. Sanson also admits the occurrence of Spontaneous Gan- 
grene to be dependent on a lesion of the sources of nutrition, as 
will be seen by the annexed history, also from my note-book. 

"Mr. Sanson, in his Clinical Lecture, related the following history of a 
curious case. A man of middle age and delicate constitution, experienced, 
about a month since, in his left hand, a sense of numbness, which gradually 
spread over the whole arm, and increased so as to give him a kind of prick- 
ing pain. He consulted a physician, who applied frictions with Tr. Cam- 
phor: brandy, &c. The symptoms, however, instead of yielding, became 
aggravated, and about a week ago the patient's fingers became of a livid 
and gangrenous color, which induced him to enter the hospital. When Mr. 
Sanson first saw him, the fingers and nearly the whole hand, presented the 
color and shining appearance of the dark blue grape ; but on examination he 
perceived, that though the temperature of the hand was lower than natural, 
yet it was not that of a dead limb. On feeling the pulse at the wrist and at 
the brachial artery, he found it extremely feeble, whereas in the healthy arm 
it was quite full and natural. After pressing the brachial artery a little and 
removing the finger, it was perceived that the circulation was completely 
suspended for several seconds, when it would reappear gradually, and ex- 
tend to the hand. None of these curious phenomena appeared in the un- 
diseased limb. To use his own words, « it appeared that by a little pressure 
on the artery, its sides were glued (colle) together, until the force of the cir- 
culation, already very feeble, would press them asunder." The hand was 
perfectly insensible, and the arm not painful, though both were a little tume- 
fied. Not knowing the true nature of the case, it occurred to Mr. Sanson, 
that it might perhaps be an inflammation of some of the blood vessels, not- 
withstanding the absence of pain ; he accordingly applied leeches about the 
wrist and along the course of the brachial artery. On the next day, to his 
great surprise, he found that the black colour had left the hand, and only oc- 
cupied the fingers. He ordered leeches to be reapplied, and on his third vis- 
it the dark colour was perceived only on the extremities of the fingers. — 
Thirty or forty leeches were applied several days more, when the line of 
separation was formed, and scvern; of the extreme phalanges removed. — 
The patient soon recovered his health." 



1836.] Phrenological Analysis. 271 



Phrenological Analysis of the Character of Allen Pace. By F. 
M. Robertson, M. D. 

" One fact is, to me, more positive and decisive, than a thousand metaphy- 
sical opinions." — Spukzheim. 

Owing to the restrictions of the government of France, there 
was no Phrenological Society in Paris, until after the late revolu- 
tion. Many may be disposed to consider this an evidence of 
the slow progress of the science on the continent ; but this is not 
the case, for no sooner was a society formed, for the purpose of 
investigating its claims to rank among the sciences, than some 
of the most distinguished men, both medical and non-medical, 
enrolled themselves among the disciples of the illustrious Gall 
and Spurzheim. Those who have not had access to the differ- 
ent Phrenological Journals of this country and Europe, will pro- 
bably be surprised to learn that the celebrated Andral is the Pre- 
sident of the Phrenological Society of Paris. 

In the Journal de la Societe Phrenologique de Paris, in the 
April number for 1835, may be found, among other highly in- 
teresting matter, a discourse from Andral, delivered at the gen- 
eral annual meeting of the society. " In this discourse," observes 
the editor of the Edinburgh Phrenological Journal, "he endeav- 
ors to remove existing prejudices, by showing that Gall's leading 
ideas are in strict harmony with the principles which have al- 
ways been followed by Physiologists, in endeavoring to discover 
the functions of the bodily organs, and that their truth is estab- 
lished by a body of evidence, direct and indirect, which it is im- 
possible to resist. He states that his aim is to prove that the 
science, of which Gall is the founder, must henceforward be in- 
cluded among the grave and serious studies of physiology." — 
The translator concludes by the following very just remark : 
" His professional reputation and labors may be put in the scale 
against any of our living teachers." 

We have made the foregoing remarks and quotations, before 
entering, directly, upon the subject of this article, to show the 
importance which is attached to this science by one of the most 
distinguished pathologists of the age, and, also, for the purpose of 



272 Phrenological Analysis. [Oct. 

refuting the charge, that none of the eminent professors of Eu- 
rope are found among the advocates of the system. Did our 
time and space permit, we could bring forward a list of the mem- 
bers of the different societies in Europe, that would astonish 
many of our opponents. 

The subject of the present communication, committed a mur- 
der in Barnwell District, S. C, for which he was tried, con- 
demned and executed. Some of the particulars of this case 
were related in an article over an anonymous signature, the au- 
thorship of which we feel no hesitation in acknowledging. The 
skull of Pace was obtained by a professional gentleman, who 
has been so kind as to permit the writer of this article to retain 
it in his possession. The developements of this skull afforded 
such a striking illustration of the doctrine of Phrenology, and ha- 
ving heard some of the particulars of the murder, casually and 
verbally, from persons who had received their information se- 
cond-hand, we were induced to make further inquiries into the 
case. In order to get at the most authentic information, we re- 
quested the gentleman who procured the skull, to communicate 
any information he might possess in relation to the character of 
the individual. He mentioned this request to a friend of his — a 
member of the bar — and shortly afterwards, the following letter 
was received, enclosing the subjoined document : 

"13th July,. 1835. 
"Dr. F. M. Robertson: 

"Sir — My friend, Dr. James O. Ilagood, of this place, has in- 
formed me that you have expressed a wish to know the partic- 
ulars of a murder committed by Allen Pace, who was hung, and 
whose skull is now in your possession. In examining some old 
law papers, I casually found the original notes of testimony giv- 
en on the trial, and which, in a leisure moment, and for a differ- 
ent purpose, I had arranged and digested. To the testimony I 
have added some particulars in relation to the arrest, appear- 
ance, trial and execution of Pace, as furnished by a professional 
friend, who was foreman of the Jury of Inquest, and saw Pace 
in the Court House and under the gallows. 

I have also had access to the finding of the Coroner's Inquest, 
the Indictment, Conviction, and other matters of record, togeth- 
er with an act of the Legislature of 1824, giving a reward to 
those who pursued and captured Pace. 



1836.] 



Phrenological Analysis. 



273 



Trusting that the enclosed narrative, though brief, will prove 
satisfactory, I remain, very respectfully, &c. 

EDMUND BELLENGER, jr. Attorney at Law, 

Barnwell Court House, S. C" 

Before giving the document alluded to in this letter, we will 
say a few words in relation to the phrenological developements 
of the skull. The following scale will exhibit the measurement 
of Pace's cranium by means of the Callipers. We regret that 
a craniometer could not be obtained, as it would have enabled 
us to have been still more minute. The skull is remarkably thin 
over the organs of Destructiveness and Secretiveness, which 
shows that the relative size of these organs was greater than 
represented by the measurement, as less allowance must be 
made for the thickness of the tables of the skull at this point than 
over the other organs. 



Greatest circumference, measured horizontally over In- 
dividuality, Destructiveness and Philoprogenitiveness, 

From Occipital spine, over the top of the head to In- 
dividuality, 

From ear to ear over the top of the head, - 

From Philoprogenitiveness to Individuality, in 



a right 



line, 



From Inhabitiveness to Comparison, - 

From ear to Philoprogenitiveness, - 

From ear to Individuality, - 

From ear to Benevolence, - 

From ear to Reverence, - 

From ear to Firmness, - 

From ear to Conscientiousness, - 

From Destructiveness to Destructiveness, 

From Secretiveness to Secretiveness, - 

From Acquisitiveness to Acquisitiveness, 

From Cautiousness to Cautiousness, 

From Ideality to Ideality, - 

From Constructiveness to Constructiveness, 

From Mastoid process to Mastoid process, 

From ear to Occipital spine, 

35 . 



Indies, 
20 1-2 

11 3-8 

12 3-8 



6 7-8 
5 7-8 
1-4 
1-8 
7-8 
3-8 
7-8 



5-8 
1-2 
1-8 
1-8 
1-8 
3-8 
1-8 
5-8 



274 Phrenological Analysis. [Oct. 

In examining this skull, we must take into consideration, not 
only the magnitude of each organ, separately, but particular re- 
ference must be had to the proportionate developement of the dif- 
ferent regions of the head. In consequence of not attending to 
this simple rule, many persons have arrived at conclusions unfa- 
vorable to the science. Upon examining the head of a murder- 
er, and that of some eminent individual, if the organ of Destruc- 
tiveness be found equally developed in both, they at once con- 
clude, without advancing a step further, that the science is false. 
They forget to examine the moral organs, which, in all cases, 
exert an influence, proportionate to their relative developement, 
in controlling the action of the inferior propensities. Destruc- 
tiveness, in a head like that of Spurzheim or Sir Walter Scott, 
merely imparts force and energetic action to the intellectual fa- 
culties in their writings and investigations, while the same de- 
velopement of the organ might exist in a criminal, though we 
should find a vast difference in the intellectual and moral region. 
Phrenologists divide heads into three classes. The jirst includes 
those in which the organs of the propensities predominate over 
the organs of the faculties peculiar to man. Those of the second 
class are of an opposite nature, and exhibit a preponderance of 
the organs of the moral sentiments and reflective faculties. The 
third class is composed of heads in which these two orders of 
organs are nearly equally balanced. On referring to the above 
scale, it will, at once, be perceived, that the head in question will 
fall under the jirst class. We find in it the organs of Amative- 
ness, Destructiveness, Secretiveness, Acquisitiveness and Cau- 
tiousness, much larger than Benevolence, Conscientiousness, 
Reverence, Ideality, Adhesiveness, and the organs of the Intel- 
lectual Faculties, all of which are very small. The forehead is 
low, narrow and shallow, from the anterior border of Construc- 
tiveness forward. In truth, the animal nature appeared to pre- 
dominate completely over the human. 

Upon examining this skull, a Phrenologist would readily per- 
ceive what would most likely result from such a combination, 
particularly in an individual of the habits and mode of life of 
Pace. 



1836.] Phrenological Analysis. 275 

The following is the document alluded to in the foregoing re- 
marks : 

" Trial for Murder, in the Court of Sessions for Barnwell Dis- 
trict, in the State of South Carolina, before the Hon. John S. 
Richardson. — Fall Term, 1824. 

'• The prisoner's name was Allen Pace, and he was charged 
with murdering Marvin Holbert, on the night of the 9th of Au- 
gust, 1824. The body of the unfortunate Holbert, as was sup- 
posed, was found in the woods, behind a log. The body was in 
a state of putrefaction, and the face so bruised that the features 
were not distinguishable ; nor were there any weapons of death 
near the spot. The defendant was arrested in North Carolina, 
and as no positive proof could be adduced, it was extremely dif- 
ficult to identify the body, to show the mode of commission, and 
to fix the guilt on the party charged. — But 

" Murder, although it hath no tongue, will speak 
With most miraculous organ." 

The body was identified by the colour of Holbert' s hair, his 
clothes, his suspenders, his shoes, the attendance of his dog, his 
being seen near the spot on the previous evening, and his other- 
wise unaccountable disappearance. 

A trail was observed, as if the body had been dragged to the 
place of concealment. This was followed for seventy yards, 
and then it became evident, on examination, that arrangements 
had been made for spending the night, and that, while the de- 
ceased was lying on his back, his skull had been battered with 
lightwood-knots and pieces of timber. And, that the prisoner had 
perpetrated this foul and revolting deed, was evidenced by the 
following facts : 

1st. It was proved that the prisoner and the deceased had been 
well acquainted ; they were both strangers in the district. Hol- 
bert had control over the other ; regulated his movements, and 
made contracts for his work. 

2d. On the morning of the 9th, they started, in company, from 
a certain house, came to the Village, remained there for some 
time, departed together, and, late in the evening, were seen to- 
gether near the scene of the murder. 



276 Phrenological Analysis. [Oct. 

3rd. They called at a house in the neighborhood for accom- 
modations — the prisoner urged his companion to go on. 

4th. Holbert was in the possession of a large sum of money, 
which had been exhibited frequently in the prisoner's presence. 

5th. When they left the Village, they travelled downwards 
and on foot On the 10th, Pace was seen hastening towards Au- 
gusta, Ga. on horseback. 

6th. Before that time, Pace was not worth more than 12 1-2 
cents — was dependent on Holbert for clothes. On the 10th, and 
afterwards, Pace exhibited a profusion of money — purchased a 
horse, saddle, &c„ for ninety-five dollars, and laid out sixty dol- 
lars at one store. 

7th. Holbert kept his money in a black silk handkerchief— on 
the 10th, Pace was seen with a great many bills rolled up in a 
similar handkerchief. 

8th. The prisoner's saddle-bags, his hat, his coat, and his pan- 
taloons — the last bloody — were found on the spot. 

9th. When Pace was arrested, he had on Holberfs hat, iden- 
tified by a private mark put on by the merchant ; and his boots, 
identified by a nail driven through the heel of one of them. 

1 0th. On the morning after the murder, the prisoner was dress- 
ed in a suit of clothes which had been carried by Holbert as dress- 
clothes ; and endeavored to pass off a note of twenty-five dol- 
lars, the property of Holbert 

11th. When arrested, the prisoner had Holbert' s watch in his 
fob. A witness on being asked how he knew the watch, said, if 
it was the same, a peculiar piece of paper, which he described, 
would be found in the case. The watch was opened in court, 
and there was the paper. 

Such was the evidence on the part of the prosecution. In it- 
self, each fact was unimportant, or, at most, could furnish no 
more than a ground of suspicion ; but, when taken in connection, 
and unexplained by the prisoner, they proved too strong for his 
escape. He was found guilty, and suffered on the gallows. He 
had been pursued and arrested in North Carolina. Though 
seized when armed and surrounded by his friends, he submitted 
in silence, and without asking the cause of his arrest. 

lie had a dark, sullen, downcast countenance; 
"A villain, by the hand of nature marked, 
Quoted and signed^ to do a deed of shame." 



1836.] Phrenological Analysis. 277 

Such was his appearance and demeanor at the time of his cap- 
ture, during his imprisonment, at the trial, and under the gallows. 

He was visited while under sentence of death, by clergymen 
of different denominations ; but the offers of religious consolation 
were received with thankless and sulky indifference. 

He denied his guilt ; but either would not or could not ex- 
plain a single circumstance, of the great many that were brought 
against him. Under the gallows could be seen the same sullen, 
villainous aspect. Immediately previous to the execution, he 
whispered in the ear of the attending minister, that Holbert' s 
papers might be found under a log — where he did not distinctly 
describe. A slight search was made at a subsequent time, but 
the papers were never recovered. Unless this could be called a 
confession, 

" He died and made no sign." 

And, perhaps, never did a more cold-blooded, remorseless vil- 
lain meet his appropriate fate. " It was a cool, calculating, mo- 
ney-making murder." For vile trash, had he, in the lonely 
depths of the forest, at the dead hour of night, risen on his com- 
panion, his friend, his benefactor, and wrung from him, at once, 
the hard earnings of his honest industry, and his life. But, bitter 
was the retribution! The wretched pelf, for which he had 
stained his soul with blood, proved one of the chief means of his 
detection. 

One other circumstance added to the deep, agonizing interest 
with which the horrible details of this case were heard — a cir- 
cumstance which might seem to impart an air of romance to this 
narrative; but it is fact and not fancy: The corpse of Holbert 
was discovered through the means of his dog, who attracted the 
notice of a passenger, and led him to the fatal spot. And when 
the dead body was buried, this faithful and affectionate animal — 
far more humane than the brutal Pace — laid down in silence on 
the grave. He subsequently returned, a distance of fifteen miles, 
to the individual at whose house Holbert had last resided ; and 
who, struck with such an instance of fidelity, offered a very 
large sum to the mother of Holbert for his dog. But it was re- 
fused. She would not, she could not part from this last living 
memorial of her murdered son. Unlike the treacherous friend 



278 Phrenological Analysis. [Oct. 

he had been true ; perhaps had striven to repel the assassin's at- 
tack. It is certain, that for three days and three nights, did he 
guard from birds of prey, the butchered and mangled body of 
poor Holbert : 

"Not quite deserted, though lonely extended, 
For, faithful in death, his mute favorite attended ; 
The much-loved remains of his master defended, 
And chased the hill-fox and the raven away." 

We would invite those who are sceptical on this subject, to 
examine the developements of this skull, and compare them with 
the history of the case — a history which was drawn up in 1824, 
without any reference to Phrenology. They cannot but admit 
the murder to have been most cruel and atrocious, having been 
committed upon a benefactor and friend. Refer to the skull and 
mark the deficiency of Benevolence, Reverence, Conscientiousness 
and Adhesiveness. They will also agree that it was to gratify 
an unhallowed thirst for money — We point to the large devel- 
opement of Acquisitiveness. They will doubtless add, that it 
was perpetrated in a most secret, cowardly and brutal manner. 
Behold the enormous developcment of the organs of Secretive- 
ness, Cautiousness and Destructiveness, in proportion to the intel- 
lectual faculties and superior sentiments. In this skull the organ 
of Combativeness is decidedly small, and his cowardice v , evin- 
ced as well by the manner in which he committed the ed, as 
by the fact that he made no resistance when apprehended, " tho* 
armed and surrounded by his friends." Persons are too apt to 
confound the functions of the two organs, Destructiveness and 
Combativeness ; but by referring to the metaphysical analysis of 
these organs, this mistake will be corrected. In fact, the devel- 
opcment of all the organs, go directly to establish the truth of 
Phrenology. A stronger case could scarcely be found. 

Circumstances formed the tissue of evidence — which may be 
regarded as strong as positive testimony — that led to his convic- 
tion. A similar chain of circumstantial evidence, presented by 
the history of the transaction and the phrenological develope- 
ments, constitutes testimony equally strong in favor of the truth 
of (he science. It has been remarked by an eminent writer, 
"that in the administration of justice, circumstantial evidence is 
often preferred to positive. It is deemed more probable, that a 



1836.] Phrenological Analysis. 279 

witness may swear falsely, cither through intention or mistake, 
than that a large number of authenticated facts, connected with 
no interested motives, should concur in supporting an unfounded 
accusation. In science, the same is true. An experimenter or 
an observer, may be honestly mistaken; or a preconceived hy- 
pothesis may tempt one to distort facts, or to prevaricate as to 
results. But a host of well-known and acknowledged phenome- 
na, harmonizing in their drift, and throwing their undivided 
weight into the scale of controverted doctrine, while neither fact 
nor analogy is adduced to counterbalance them, would seem to 
be conclusive." 

Perhaps the oft-repeated objection may here be reiterated: 
"Admit your science to be true ; then this individual was neces- 
sarily impelled to the commission of the deed, as he possessed 
the bad organs, and therefore should not have been held accoun- 
table for the act." But this is begging the question. Phrenolo- 
gy does not recognise any bad organs or faculties. They are 
all good, and intended to serve some wise purposes, within their 
proper spheres ; and only become bad in their effects, when suf- 
fered to transcend their legitimate bounds of action. Neither 
does the doctrine lead to the conclusion drawn in the above ob- 
jection. We only say, that out of any number of individuals, 
those who possess an organization similar to the one in question, 
will be more likely, under given circumstances, to yield to the 
influence of temptation, in consequence of the preponderance of 
the animal propensities, than those who possess developements 
that would bring them under the second class — where the moral 
sentiments and reflective faculties predominate over the animal 
nature. We do not speak of what ought to be, or of what we 
should like ; nor pretend to inquire into the justice of the econo- 
my of the moral constitution of man. This is alone the preroga- 
tive of the Creator. We must take tilings as they are, and ex- 
amine "xcts as they are revealed in nature. Do we not find, in 
our d: y intercourse with society, individuals who arc invaria- 
bly the same — who do not yield to temptations, which, under the 
same circumstances, overcome others immediately I These, as 
it has been said, "arc a lam unto themselves'* We always find 
them pursuing the same just and equitable course. But there 
are others again w T ho require all the rigor of the lex scripta, du- 
ring their whole course through life. Do wc not come in con- 



280 Phrenological Analysis. [Oct. 

tact with those who are proverbially bad ? — who are kept in 
bounds, only by the rigid enforcement of the laws of the land ? 
Does not every one repose more confidence in the word of honor 
of some men than in that of others ? Who ever thinks of trust- 
ing a thief? A man who will commit fraud, in one instance, will 
seldom be found to suffer an opportunity to pass unimproved, 
when he can over-reach his neighbor, or swindle his creditors. 
What says the law on this subject ? A Judge who is impeach- 
ed and convicted of mal-practice in office, is not only removed 
from his responsible post, but rendered ineligible, ever afterward, 
to any office of honor or trust. A man once convicted of per- 
jury, his oath is never afterwards admitted as evidence in a court 
of justice. How seldom is one cold, deliberate, calculating mur- 
der, the last committed by one who has taken the first step in his 
career of destructiveness, unless conviction and the penalty of 
the law arrest his murderous course. For the truth of these re- 
marks, we appeal to the annals of crime in all ages. These are 
facts in nature, independent of Phrenology. Whether this doc- 
trine be true or false, they stand as facts beyond dispute. In 
accounting for them, it is immaterial, so far as accountability is 
concerned, whether we assign them to native goodness of char- 
acter, in the one case, and natural depravity in the other, or to 
the relative degrees of developement of the different organs of the 
faculties. Take it which way we will, the accountability is 
neither lessened nor increased. The results are invariably the 
same. 

It is to be regretted, for the sake of truth and justice, that those 
who attempt to disprove Phrenology, do not resort to the exam- 
ination of facts. Few investigate for themselves ; the majority 
simply depend upon the assertions of the enemies of the science, 
and content themselves with the knowledge thus obtained, in- 
stead of consulting authentic works on the subject, and testing 
its truth by an appeal to facts. 

Augusta, August, 1836. 



1836.] Fracture of ike Os Femaris. 281 



Cases of Fracture of the Os Fentoris — Adjustment by weigM and 

fulcrum : 13 y M. Antony, M. D. &c. &c. of Augusta, Ca. 

My purpose in this paper is to call attention to the treatment 
of fractures of the femur, by weight and fulcrum. In doing this 
I will illustrate the practice by a brief account of live cases, se- 
lected from amongst others. 

Case 1. A negro man, aged 40 years, whilst engaged in dri- 
ving his wagon, fell from his horse, and the wheel of the wag- 
on passed over one of his thighs. The accident terminated in 
the dislocation of the knee-joint, and a simple fracture of the fe- 
mur of the same side, at the upper end of its lower third. I vis- 
ited him on the road where the accident occurred ; reduced the 
dislocation, and adjusted and confined the fragments in place with 
temporary bandage and splints, to prevent irritation whilst be- 
in^ brought to town. 

So soon as he arrived at lodgings, I put him on his back on a 
firm bed of planks, covered With blankets ; and placed under the 
upper third of the tibia a cylindrical billet of wood about six 
inches in diameter, wrapped with several coverings of cloth. — 
This was so far from the thigh, as barely to touch it, without 
pressure. A short roller bandage was then passed around the 
ankle and the bottom of the foot, where a string was attached, 
which, passing over the foot of the bed or platform about six inch- 
es beyond the heel, suspended a piece of brick, weighing about 
two and a half pounds. After adjusting the fragments by exten- 
sion and counter-extension, made by the hands of assistants, four 
short splints made of veneering, were then placed on the thigh 
and secured by a many-tailed bandage, as snugly as possible, 
without being uncomfortable. The thigh had swollen consid- 
erably, and was directed to be kept wet with a suitable solution 
of acetas plumbi in water and vinegar. The toes were proper- 
ly directed by a small slip of bandage, and secured to the bed 
on each side of the foot, at a distance of 18 or 20 inches, whilst 
the foot rested on the heel. Another slip of bandage was passed 
over the breast and under each shoulder, and pinned to the bed 
above his head, for the purpose of counter-extension; but the 
weight <>1 the bod} being soon found sufficient, it was dispensed 



282 Fracture of the Os Fcmoris. [Oct. 

with. This case required no farther assistance, except occa- 
sionally tightening the many-tailed bandage as the tumefaction 
of the thigh decreased. After two weeks, the weight was laid 
on the foot of the bed, except when the patient was asleep. At 
three weeks, the short splints were removed and the limb re- 
freshed by gently rubbing with a wet cloth ; after which they 
were re-applied, for a week or two, and the patient discharged. 
Six months after, I met this patient in the road walking and dri- 
ving his wagon. He stopped to manifest his gratitude, when I 
requested him to perform several exercises for my inspection, 
such as walking, running, leaping and dancing; all of which were 
performed without the least imperfection of the limb being man- 
ifested. 

Case 2. This was a lad, about 11 years of age, one of the 
most rude, uncontroled and uncontrolable, in the city ; who had 
by a fall from a cypress tree, suffered a fracture of the femur, a 
little above its middle. The patient was laid on his back on a 
firm mattrass placed on a table. A fulcrum for the upper part of 
the leg was prepared by rolling a soft pillow transversely on it- 
self, so as to render it very firm. A half brick was suspended to 
the foot, by a string passing over the lower end of the mattrass, 
some six or eight inches from the foot — the fragments adjusted, 
and short splints applied as in the other case. A counter-exten- 
sion bandage was, on account of the ungovernableness of the pa- 
tient and lightness of his body, thought necessary and applied in 
this case ; but this restriction from movements, he used every 
opportunity afforded by the absence of his attendants, to rid him- 
self of; until after a few days it was dispensed with. Such was 
his impatience of restraint from motion, that so soon as the great 
soreness in the wound began to abate, he was often found sitting 
on his bed, having raised his body by pulling the pavilion which 
was suspended over him to protect him from flics in the day 
and musquitoes in the night. The patient was however dis- 
charged well in the fourth week : no untoward circumstance ha- 
ving occurred. 

Case 3. This was a very rude and ungovernable girl, in her 
seventh year, who in attempting to slide down the hand-rail of 
the stair -way, as she was wont to do, fell from near the top of 
the first flight, to the floor ; fracturing the femur a little above its 
middle. She was placed on a mattrass, which was laid on the 



1836.] Fracture of the Os Femoris. 283 

dining table, and a fulcrum made of a pillow, placed beneath the 
upper part of the leg as in the other cases just described, and a 
weight of one pound and a half suspended to the foot and pas- 
sing over the end of the table; with a counter-extension bandage 
passed over her breast, short splints, &c. as before described. — 
This patient was of strongly marked sanguineo-nervous tem- 
perament, and was much disposed to spasmodic twitchings du- 
ring sleep, from irritation in the wounded thigh, for the first 48 
hours. As this irritation subsided, she became free and slept 
quietly. During her waking hours she became very restive, so 
that her arms and sound leg were perpetually engaged in some 
exercise or other for expending her super-excitabrlity. The 
counter-extension bandage was necessarily retained in use to 
prevent her from rising, and from sliding too near the foot of her 
bed. 'In the course of a week or ten days, however, she had 
become so subdued by its eontroling influence, and so desirous 
to be released from its use, as a means of restraint to which she 
seemed to abhor subjection, that she was easily retained in her 
place without its use. The wounded limb having ever remained 
still since the subsidence of the first irritation, it was found safe 
after eight or ten days to rest her, when awake, from the little 
pressure of the one and a half pound weight which hung to her foot, 
by placing it on a chair, or on the bed during her waking hours. 
All went on favorably in the case until four weeks had elapsed 
when she was liberated from all the apparatus and allowed free 
motion on her bed. On comparing the length of the wounded 
with that of the sound limb, before she began to walk, the for- 
mer was found four or five lines longer than the latter, from the 
extension of the articulations during the suspension of muscular 
action in the limb. On walking, the limb at once resumed its 
proper length, and like the other cases left no deformity in gait 
or shape. 

Case 4. This was a negro boy, about 10 or 11 years of age, 
who fell from a wagon heavily laden with nine bales of cotton, 
which ran over his thigh on very hard ground, leaving a com- 
minuted fracture of the femur, extending from about the middle 
of the bone upwards, the full extent of between four and five 
inches, with considerable swelling, and a small external opening 
which constantly discharged blood. This patient was treated 
in the same manner as those above, except that the swelling was 



284 Fracture of the Os Femoris. [Oct. 

gently compressed so as to cause a discharge of the blood effused 
within, as effectually as possible ; and the bandage and splints 
so applied as to afford convenience for daily dressing the 
external wound. This case, occurring during the medical lec- 
tures in this place, was exposed to the frequent observation of 
the pupils of the class and daily dressed by some of them, and 
was discharged well at four weeks ; three short splints being 
however retained on the limb until he should arrive at home, a 
distance of more than 70 miles, whither he had to be conveyed 
in a common wagon. No difference was perceptible between 
the wounded and sound limbs, except the hardness at the scat of. 
this comminuted fracture, of about double the diameter of the 
bone of the other thigh, and a little increase in the length of the 
limb. He was sent home and did well in all respects. 

Case 5. This is the last case which I shall give. It was in a 
little girl nearly 3 years old, who caused a garden gate to fall on 
her, which fractured the left femur, a little above its middle. — 
For this, a small pillow was rolled so as to make a fulcrum about 
three and a half inches ill diameter, and a pound weight suspend- 
ed to the foot by a string passing over the end of the table as be- 
fore. The counter-extension bandage was applied; but this was 
a sprightly, active cjiild, who would not submit to its continued 
use ; it was dispensed with after the first day, and its place sup- 
plied by the hand of an attendant being kept almost constantly 
on the lower part of the abdomen and pelvis ; and when by her 
various little muscular movements, she was brought too near the 
end of the table, she was gently drawn back by the hands ap- 
plied to the axillae. This case was managed in all respects as 
the rest. No extension and counter-extension were needed in 
adjusting the bones, the limb being found on measurement after 
applying the weight, to be restored to its proper length, and the 
bones well adjusted. At the end of three weeks, the weight was 
finally dispensed with, and the splints taken off for the refresh- 
ment of the limb, and reapplied to guard against accidents from 
the sprightly, actfve disposition of the child. She was then re- 
moved to a bed and left to the attendants, to be kept on bed a 
week or ten days longer — continuing the splint-'. 

In giving the above live cases, I have made a selection from 
all the cases which have occurred in my practice for the last 
eleven or twelve years, all of which have been treated on the 



1830.] Fracture of t lie Os Feinoris. 285 

plan herein detailed, and with like success. My purpose in se- 
lecting these, has been to present the greatest variety which my 
practice has afforded, in different respects interesting, in proof 
of the merits of this plan of treatment. The first case presents 
an athletic laboring man, of rigid fibre, and aged 46. years, whose 
voluntary and locomotive muscles, (the displacing powers) were 
overruled by the trifling weight of about two and a half pounds, 
in steady action. The second and third present Sanguine and 
sanguinco-nervous temperaments at the most irritable and un- 
governable age, and both of them having never been subjected to 
government when well. The fourth case is selected on account 
of its being one of extremely comminuted, and of compound na- 
ture ; and the fifth, a child less than 3 years old. In the man- 
agement of fractures on this plan, the excretions are easily dis- 
posed of by the use of cloths and oil-cloths, and of urinals or 
sponges, according to the age, &c. of the patient ; and no distress 
whatever is suffered by painful compression of any of the dres- 
sing — confinement from exercise constituting the chief source of 
affliction attending the recovery. 

Duty to the science of Surgery, as well a^ to the cause of hu- 
manity, seems to demand of me this exposition of my practice in 
cases of fracture of the femur, whjch establishes in the most sat- 
isfactory manner, the propriety of a plan of management at once 
calculated to ensure the best success, with the simplest appara- 
tus and the least distress. 

Of this invaluable improvement in surgery I can speak the 
more freely, because it is not an invention of my own. The 
course of management herein detailed, is so rational, and at the 
same time so simple, that I am not only surprised that the pro- 
fession did not lay hold on it when first suggested ; but that my- 
self, or any one else, should ever have contemplated the condi- 
tion of a fractured femur, the displacing powers, and the cura- 
tive resources of the system, without having it at once suggested 
to his mind. One would suppose that even necessity, the parent 
of so many discoveries, would, on some occasion, nave sugges*- 
ted it very early in the practice of surgery. During the first 
fifteen years of my professional life, I was in the habit of applv- 
ing the various apparatus under recommendation by different 
eminent surgeons, as Dessault, Physic, &c. &c., having for their 
chief merit, adaptation to the purpose of preserving juxtaposition 



280 Fracture of the Os Femoris. [Oct. 

by great extension and counter-extension. Such was, however, 
the severity of pressure on the points where extension and coun- 
ter-extension were made, that I often found my patients most 
ungovernable, or more or less severely afflicted with excoria- 
tions, and sometimes with alarming ulcerations. Indeed, so dif- 
ficult, troublesome and painful, was "the setting of the bones" as 
it is called — so distressing was the treatment, and so doubtful 
the result under the most approved plans from time to time in 
use, that I became exceedingly averse to encounter a fracture of 
the Os Femoris, on account of my feeling for the unavoidable 
sufferings of the patient, or his chance for a crooked or a short 
limb. 

In the early days of the Boston Medical and Surgical Journal, 
I first observed on its pages, (if my memory be correct,) an ac- 
count of the experience of my friend, Dr. Wm. C. Daniel of Sa- 
vannah, with this mode of practice, which was to me perfectly 
new, and so evident an improvement, that I determined on adopt- 
ing its use in the first case which should occur. Soon after- 
wards, however, I observed some suggestion of the same plan, 
of a much older date ; but which had of course escaped Dr. Dan- 
iel's observation, as it had my own. I adopted its use, however, 
with the exception of the pully, over which he advised the cord 
suspending the weight to pass. This I found unnecessary ; as 
the motion was sufficiently free over the end of the mattrass, or 
of the table. 

The principle on which this plan of treatment operates, must 
be evident to all. In the first place, the inconsiderable weight 
attached is often sufficient to adjust the bones ; and always suf- 
ficient by its steady action, to exhaust the active energies of the 
muscles of the limb, long before union commences, and before the 
soreness of the part is so removed as to render the patient wil- 
ling to effect any motion of it. The constant, though gentle trac- 
tion secures the proper length and straightness of the limb, and 
the short splints, bound on with moderate and easy force, is a con- 
stant safeguard against accidental movements of the fractured 
ends, which would tend to irritate the soft parts, and render union 
doubtful. From my experience with the retaining power of this 
dressing, I feel assured that no plan is so well calculated to se- 
cure success in cases of fracture of the neck of the Os Femoris, 
(a case always produced by violent motion of the pelvis down- 



1836.] Meteorological Observations, §c. 287 

ward, relative to the femur,) as it would, with the help of the 
muscles of the part, very securely retain the fragments in appo- 
sition with great steadiness, especially if the pelvis were well 
fixed to the mattrass; whilst the weight of the body would af- 
ford counter-extension, without the pressure of a counter-extend- 
ing bandage, which might tend in any degree to displace the up- 
per fragment. 

In conclusion, I will observe, that from the excellent adjust- 
ment preserved, I have ho doubt the splints and weight might 
have been removed still earlier than they were; but I was un- 
willing to risk any thing in experimenting, to determine how ear- 
ly they might be safely dispensed with. 

Augusta, August, 183G. 



Meteorological Observations, fyc.for Burke and Richmond Coun- 
ties* Extract from the Geological Survey of the two Counties. 
By Professor J. R. Cotting. 

Greatest heat at sunrise, - - - 74 ° 

Least heat at sunrise, - - 62 

Greatest heat at 12 o'clock, - - - - 92 

Least heat at 12 o'clock, - - - 78 

Mean heat of the first half of the month, - 80.68 

Mean heat of the last half of the month, - - 75.5 

Mean heat of the whole month, - - - 77.2 

Coldest day, August 31. Warmest day, Aug. 5. 
Rain Guage, 6 inches 8 lines. Foggy mornings, 7. 
Cloudy days, 6. Rainy days, 3. Thunder showers, 11. 
Prevailing winds, NE., S. and SW. 

From the 19th to the 31st, there were no thunder showers, the 
longest interval that has elapsed since May ; still the air has 
been very serene, and the Counties remarkably healthy for the 
season. 

The mean temperature of these Counties for August, differs 
about 4 ° from that of Cambridge, Massachusetts. The form- 
er being 77° 2; the latter 72° 16. 



288 Analysis oft species of Clay, tyc. [Oct. 



Analysis of a species of Clay found in Richmond County, which 
is eagerly souglU after, and eaten, by many people, 'particular- 
ly children. By Professor J. 11. Cottixg. 



100 1-3 grains Troy 



Silox, 


31 


Oxide of Iron, 


- 12 


Alluniina, - 


34 


Magnesia, 


- io 


"Water, - 


12 1-3 


Loss in Analysis, - 


- 1 




100 1-3 grains. 



This substance, in its external characters, resembles Litho- 
marge, or Hock Marrow. Colours, dark red, yellow, yellowish 
red, yellowish white, purple and reddish white. Occurs massive 
and stratified, strata undulating, opake, fracture conchoidal and 
earthy; texture, fine grained; soft; may be polished with the 
linger nail ; adheres slightly to the tongue ; gives a faint argilla- 
ceous odour when moistened, or breathed on ; has the feel of 
hard soap ; falls to powder in water, but docs not form a ductile 
paste. Spec. grav. 2.53. 

But its chemical characters and geological position, rank it 
with the talcose family. It appears to have resulted from the 
decomposition of talco-micaeous slate, which is found in the vi- 
cinity. It underlies the ferruginous sand [formation , and silici- 
ous rocks called pitchstone, resting on light sandy clay. I have 
not been able to detect any organic remains of animals in the 
formation. It sometimes contains vegetable remains in the state 
of petrifaction and lignite. That it must have been the result of 
the decomposition of older rocks, is evident from the above an- 
alysis, its geological position, and from the fact of its containing 
fragments of older rocks notinpla.ee. I found it associated with 
other minerals in many parts of the survey, in both the Coun- 
ties of Burke and Richmond, but the purest and most abundant 
was on land of David F. Dickinson, Esq., near M'Bean Creek, 
Richmond County, on the east side of the great road leading 
from Augusta to Savannah, about fourteen miles from the for- 



1 836.] Analysis of a species of Clay, <$-c. 289 

mer place. Here large excavations have been made by ignorant 
dirt-eaters to obtain it. 

It has a slight sweetish taste, not unlike calcined magnesia ; 
which property, combined with a certain morbid state of the sto- 
mach, has probably induced to the unnatural, filthy and danger- 
ous use of it. Its action is mechanical on the stomach, as it con- 
tains nothing capable of being decomposed, and nothing on which 
the gastric juice can act. This juice, although it is capable of 
corroding iron and steel, as is found by experiment, has no action 
on silex. It is a well known property of silex, that it will wear 
away, or polish the most obdurate metal. It is an extremely 
hard, brittle substance, in minute divisions, this adheres strongly 
to the coats of the stomach, causing irritation of that organ, de- 
rn nging the appetite for wholesome food, inflammation ensues, and 
if persisted in, death. I am informed by respectable people liv- 
ing in the vicinity of localities of this mineral, that many deaths 
have occurred from no other perceptible cause, than from per- 
sisting in the use of this dirt as a luxury. 

We find it universally the case with these habitual dirt eaters, 
that their countenances present a sickly, palid, cadaverous hue, 
not unlike those mechanics whose constant occupation is polish- 
ing metals, who are generally afflicted with disorders of the chest 
and sooner or later fall victims to consumption. 

A boy about fifteen years of age, whom I met at the above 
locality, taking his favorite repast, informed me that he was in 
the habit of eating daily of that substance, "as much as he could 
hold in his hand." Admitting his statement to be true, and judg- 
ing from the specific gravity of the substance, he must have swal- 
lowed daily, nearly an ounce of pure flint ! He might, with 
greater impunity, have swallowed as much white sand of the 
pine woods, because in that the particles are rounded by attri- 
tion, and in this they are angular, and the angles very sharp, 
like the edges of broken glass. I asked the boy if his parents 
did not inform him better ! He said, " he had only a mother and 
she ate it too, when she was well, but she was almost always 
sick." 

This peculiar species of clay is said not to be found north of 
the Potomac ; a species in some respects similar, is found at 
Bare-hills, Maryland. That, however, is deficient in the pro- 
portion of iron and magnesia. 

37 



290 Note to Professor Cotting's Piece. [Oct. 

This substance may be employed as an excellent substitute 
for Fuller's earth, in the dressing of woollen cloth. 



Note. — A very general error has, in our opinion, always pre- 
vailed to a great extent, on the subject of the location of this 
practice of dirt eating, in the series of phenomena which consti- 
tute the chain of cause and effect. Nor is this an error of trivial 
importance, so long as effects depend on causes for their produc- 
tion. In medicine it is peculiarly dangerous, inasmuch as it 
tends to conceal, or divert attention from primary causes, by 
which, whilst they continue, subsequent effects must be perpet- 
uated. 

All-important as it is considered, diagnosis itself is less indis- 
pensable than causality, in connexion with morbid phenomena. 
The reason of this is, very obviously, that in the institution of 
new causes, (which is the purpose of therapeutics,) the effects of 
which are to be the correction or removal of some cause or 
causes present in the concatenation of disease, the new causes 
or powers thus instituted, must be endowed with some character- 
istics peculiarly adapted and proportioned to the effects in view, 
viz. the removal or correction of the present noxious cause. It 
is as plain as that an alkali must be possessed of the peculiar 
powers and qualities of its nature, to be calculated for the cor- 
rection of an excess of acid introduced into the stomach. But if 
an excess of acid abound in the stomach in consequence of func- 
tional lesion of the stomach itself, whilst an alkali will tend to the 
palliation of the symptoms and distresses, it will not be calcula- 
ted for the correction of that organic lesion, which caused the 
acidity. The best consequence then which may be rationally 
expected from the use of an alkali, would be a temporary palli- 
ation of the distresses of sour stomach : whilst in the other case, 
or that which supposed acid introduced, it would effect curative 
ends which nothing else could. But let us illustrate with the 
case directly in point. 

If dirt-eating be looked to as the cause of the attending phe- 
nomena, as curative indications must have a peculiar adaptation 
to the end to be effected, all attention and effort must be directed 
to the purpose of confining the patient from the supposed nox- 
ious power. Now it is certainly true, that the unnatural articles 
taken into the stomach in cases of Bulimia, or depraved appe- 



1836.] Note to Professor Cotting's Piece. 291 

tile, often, perhaps generally exert noxious influences on the 
system in some way or another. The withholding the patient 
then, from the use of such unnatural and injurious articles, is 
right, and calculated to palliate some of the troubles in the case 
which arise secondarily ; but still the health of the patient, with- 
out the operation of other causes or influences, not only fails to 
recover, but continues to decline, just as surely as that a man 
would continue to be wet who should stand in a shower of rain, 
and constantly wipe away the water to make himself dry, in- 
stead of spreading his umbrella over him. In this case, he must 
do both. He must remove the water already on him and ward 
off from him, by the use of his umbrella, that which would con- 
tinue the wetting. 

1 have never succeeded in curing these cases by directing my 
indications solely to the taking in of unnatural articles: for with 
this alone, the disposition continues. I have removed from the 
primae viae the indigestible accumulations which have been found 
there, and withheld the article for the future ; but the patient 
would resort to others, as paper, rotten wood, bark, old rags, &c. ; 
and in one instance, I recollect that a youth of about 14 years of 
age, consumed for his last precious morsel, a whole pair of Os- 
naburg pantaloons, with the exception of the waistband and 
some small part of the seams. Thus it is, that although purga- 
tives often remove those offensive things, they cannot, simply as 
such, essentially and radically benefit the case. The truth of 
this case is, that the habit, as it is considered, of dirt-eating, or 
any of the displays of depraved appetite, is to be looked on 
mainly as a phenomenon consequent to and perpetuated by its 
own peculiar cause ; and whilst it is the duty of the practitioner 
to remove from the system unnatural ingesta, with as much cer- 
tainty as if they had been accidentally introduced, it remains his 
paramount, and consequently indispensable duty to correct the 
cause whereof this is the effect. A new set of causes have then 
to be searched for. They are those which wrought out the im- 
pairment of the normal condition of the stomach, &c, and plan- 
ted in its stead a desire for things indigestible, unprofitable and 
deleterious. Such a case is very analogous in its philosophy to a 
case of dropsy. If an hydropic accumulation take place acci- 
dentally, the cause of which is not continuous, as simply a check 
of perspiration, or the compression of pregnancy, its removal is 



292 Note to Professor Cotting^s Piece, [Oct. 

a matter of trivial concern — nothing being more easy than to 
cure such a case, by removing the obvious effect, the cause of 
which is not now operative for its renewal or perpetuation. It 
is just so when we contemplate the effects of Bulimia, produced 
accidentally, or without that depraved condition of stomach, 
which is so calculated to perpetuate them. But if dropsical 
phenomena be perpetuated as fast as they'are corrected, the mind 
must, if it have not before determined this point, go in search of 
other anterior lesions, structural or functional, which, although 
themselves the effects of other and more remote causes, become 
the cause of the phenomena of dropsy. Precisely similar is the 
case of the dirt-eater. He feels as absolutely compelled to eat 
improper substances, as the healthy man does wholesome food. 
This act is as legitimate a consequence of the state of his system* 
as the act of eating wholesome food is of that of the healthy in- 
dividual. Each eats that to which his stomach most strongly im- 
pels him. But the two individuals eat things diametrically op- 
posite — one partaking of nutritious, digestible and salutary arti- 
cles, whilst the other, of such as are perfectly indigestible, innutri- 
tious and injurious. Like causes produce similar effects. It is a 
healthy condition which alone impels to the eating of wholesome 
diet. Every appreciable deviation from health is disorder : there- 
fore, as in the other case, unwholesome and unnatural articles 
are commanded by the appetite, it follows that the organ of ap- 
petite deviates from healthy condition, and is therefore disor- 
dered. 

We remember the days when that mighty corrector of visce- 
ral derangement, calomel, was weighed out with all the care and 
nicety that gold would have been, and was in but little use ei- 
ther by practitioners or the common people. In those days 
there were twenty dropsies for one now ; and although our ac- 
quaintance was then limited to a very small circle, comparative- 
ly speaking, still it is obvious that there were twenty, if not dou- 
ble that number of dirt-eaters then, for one at the present day 
when calomel is in universal use. — Eds. 



1836.] Stricture of the Urethra treated by Excision. 203 



Stricture of the Uretlira, successfully treated by excision of the 
indurated portion of the canal. Reported by William Henry 
Robert, Student of Medicine. 

Ellick, a negro man about 40 years of age, belonging to Mr. 
J. P. Setze, had been afflicted with Stricture of the Urethra fif- 
teen years, during which period he was treated by several phy- 
sicians of this city and its vicinity, and repeatedly relieved by 
the application of caustic and bougies. The disease, however, 
always returned soon after the abandonment of the bougies. — 
The man says he has never had gonorrhoea, but was troubled 
with gleet a long time. He was placed under the care of my 
preceptor, Professor Dugas of this city, who, on examination, 
found the stricture situated about three inches from the orifice of 
the Urethra; the induration was easily felt externally, and^ex- 
tended nearly an inch along the course of the canal. Attempts 
to introduce a bougie, even of the very smallest dimensions, were 
made in vain during several days ; the urine continually oozed 
o,ut by drops, the patient being unable to empty his bladder. He 
had been in this aggravated state one month. The impossibility 
of introducing any dilating instrument, and the fear of inducing 
total occlusion by the use of the caustic, together with the re- 
flection that the latter remedy had already several times failed 
to give permanent relief, determined Dr. Dugas to remove the 
indurated portion of the Urethra with the knife. The operation 
was performed on the 7th of June last. A longitudinal incision, 
made through the integuments on the median line, exposed the 
canal and permitted the excision of its diseased and thickened 
portion, through which it was found difficult to pass a wire the 
size of a common bristle. A gum elastic catheter of the largest 
caliber was introduced into the bladder, and the lips of the wound 
drawn together with adhesive strips. 

June 12th. Wound healed by adhesion ; the patient has suf- 
fered no pain from the catheter, which still remains introduced ; 
urine slightly tinged with blood ; cream of tartar and nitre for 
common drink ; catheter to be drawn half out, in order to relieve 
the bladder. 

1 5th. Catheter being bad was removed, and another intro- 



294 A Case of Monstrosity. [Oct. 

duccd four hours after, without difficulty or pain ; urine limpid; 
some appearance of two very small fistulae, through which a 
little pus escapes from the wound ; adhesive strips renewed dai- 
ly, and catheter continued. 

20th. Small fistulas entirely closed ; urinates without cathe- 
ter, and without pain ; purulent discharge from the orifice of the 
urethra pretty free ; metallic (pewter) bougie substituted for the 
elastic, and kept introduced only through the night. 

July 1st. Is apparently quite well, wears the bougie two or 
three hours daily, as a precautionary measure. 

Sept. 1st. Discontinued entirely the use of the bougie about 
a month ago, and has felt no inconvenience since. Urinates now 
in a bold stream, and savs he " is as well as he ever was in his 
life:' 

Augusta, Sept. 1836. 



A Case of Monstrosity. By D. Waties M'Junkin, M. D., of 

Tyrone, Georgia. 

The object of the present short communication, is simply to 
relate a singular case of Monstrosity, which occurred in my prac- 
tice a few years since. Those who believe in the influence of 
the mother's mind over the child in utero, would certainly regard 
it as a strong proof of the truth of their doctrine. To say the 
least, it is a remarkable coincidence and can not be satisfactori- 
ly accounted for on any other principle. 

Mrs. was threatened with miscarriage about the sixth 

month of gestation, which accident was determined by the vio- 
lent and ridiculous interference of an ignorant midwife, such as 
attempting to thrust her hand through the parietes of the uterus, 
mistaken for the membranes ; making her ride on a hard trotting 
horse, <fec. I was called in time, not to prevent or repair the dam- 
age committed by the foolish old woman, but to officiate in the 
accouchement and observe the product which, from its peculiar 
formation and the magnitude of its several dimensions, can not be 
regarded otherwise than as a monstrous birth. 



1836.] A Case of Monstrosity. 295 

The admeasurement was made as particularly as the place 
and circumstances would allow. Its length was 19 inches ; from 
one acromion scapulae to the other, 7 inches; its feet 4 inches in 
length. There was absolutely no neck, its head being placed 
upon the shoulders similar to that of a toad. The bones of the 
head were deficient in number. The parietal bones and the front 
part or edge of the temporal, being all that were present. The 
internal concavity of these was not manifest, they appeared to 
stand almost perpendicular from the base of the cranium, leav- 
ing a triangular space between them unoccupied by bony mat- 
ter, but by a dense membrane of a velvet feel, and the colour of 
coagulated blood; which inclined downwards and backwards, 
from the root of the nose, or where the ossa nasi should have uni- 
ted with the 05 frontis. From the superior anterior portion of the 
right parietal bone were five cysts, running in a straight line to 
the internal angular process of the right orbit. These cysts con- 
tained a fluid, of a bright purplish hue. The middle one of these 
cysts was the largest, which was about the size of a common 
bullet, and from this they gradually decreased in size each way 
from the centre. The hair was very thin over the parietal bones ; 
the eye swere prominent and situated upon the sides and near the 
superior portion of the parietal bones. Its nose was very small 
and in some respects resembling the human nose, but more like 
the nose of a frog. Its ears were uncommonly small and very 
thick, and destitute of the helix. The mental portion of the an- 
terior maxillary bone was contracted to a mere line and the body 
of the same very deficient — properly speaking it had no chin at 
all. There were evident signs of life for about three minutes 
after the funis was divided. Taking a general survey of the head, 
the peculiarity and deficiency of the several portions, the appear- 
ance almost exact of the Tarus Rana, or bull-frog, was presented. 
There was no other part of the body deformed. 

I regret much the opposition of the parents prevented a more 
minute investigation. It was difficult to overcome their preju- 
dices sufficiently to make any examination at all. I could not 
obtain a minute history of her case during gestation. All that 
she was willing or able to say was, that during pregnancy she 
desired, or in her language, " longed for fish, and that while she 
was one day devising means to catch some small fish that were 
sv aiming in shallow water, a large bull-frog suddenly presented 



290 A Case of Monstrosity. [Oct. 

itself. She imagined herself soon after conception to feel much 
heavier than in her former pregnancies at the same period ; and 
as gestation advanced, she was evidently more prominent 'than 
usual. The sensation of heaviness was so great that she was 
incapacitated to attend to her domestic duties. She frequently 
remarked that the " child lay so heavy, and across her back, that 
she could not get about." 

Whether the above circumstance had any influence upon the 
contents of the gravid uterus, or whether it can be more justly 
attributed to some other cause, I leave for others to determine. 

If the foetus were so large at six months, what a monster would 
it have been at nine ! 

Imagine two thin pieces put on the sides of a frog head, or 
rather on the eyes, forming a kind of fork by the parietal and 
temporal bones, and you will have almost the exact appearance 
of this monster's head. 

I have finished the task I proposed, in recording the case — the 
mother was frightened early in pregnancy by a frog — and the 
foetus had a head very similar in form to that of a frog. These 
are the facts, let our wiser elders explain them. 



1836.] Surgery Illustrated, $c. 207 



Part II.— REVIEWS AND EXTRACTS. 

ISurgery Illustrated. Compiled from the works of Cutler, Hind, 
Vclpeau and Blasius. By A. Sidney Doane, A. M., M. D., 
with two hundred and eighty Illustrations in fifty-two Plates: 
pp. 200. Published by Harper <$> Brothers, N. York; 1836. 

We have carefully examined this new publication, in order to 
give it a full and candid notice in the Southern Medical and Sur- 
gical Journal. There is one characteristic feature about its au- 
thor which all must admire — that deserves our highest encomi- 
ums — it is the industry he displays in his profession. Few in- 
deed exhibit more ambition to be useful in getting up new pub- 
lications in medicine than Dr. Doane. On an extra sheet attach- 
ed to the Surgery Illustrated, we find his name connected with 
no less than ten works, eight of which have already been publish- 
ed within a few years, and two are now in the press. Notwith- 
standing they consist of translations, compilations or new edi- 
tions, still they are the result of great industry and patient labor. 

The work now under consideration, professes to illustrate the 
operations of Surgery by plates. Of these there are fifty-two in 
number, containing no less than two hundred and eighty figures. 
They are intended to exhibit the dressings, bandages and splints 
now employed in surgery; then follow the appearances of the 
different fractures of the extremities, the positions of the bistou- 
ry, sutures, ligatures to arteries, amputations, operations on the 
eye, for the removal of stone in the bladder, &c. with the various 
instruments for performing each. This work is of royal octavo 
size, and contains a text of 200 pages — the price of which, at 
Richards & Stoy's in Augusta, is 85 50. 

We cannot speak very highly of the execution of this work. — 
The plates and figures designed to give it value are very poorly 
gotten up. Those on dressings, bandages and splints, add noth- 
ing to what we have had already, particularly from Gerdy. We 
seriously object to those on fractures of the extremities, be they 
even exact copies of the originals. They fail in the object intend- 
ed — they do not illustrate the subject of fractures. We ac- 
knowledge this to be a very difficult task to execute; but these 
plates might have been better shaded. Here too is a very im- 
portant omission in surgery ; we have nothing on dislocations, 
no illustrations of a class of the most frequent and interesting of all 
surgical afflictions. We do not understand the figure, nor the 
directions given for the continued or glovers suture, nor do we 
acknowledge the importance ascribed to it in this work. The 
description and the preparations for applying ligatures to arte- 
ries, though taken from Velpcau, are very obscure in the trans- 

38 



298 Surgery Illustrated, §c. [Oct. 

lation. The frontispiece, which also serves for the sixth regular 
plate, is a very meagre affair, and of little or no use in illustra- 
ting the subject to which it refers. In plate 37, in both opera- 
tions the saw is held in the left hand, and is represented as work- 
ing from left to right, across the chest of the operator, instead of 
forward and backwards. In plate 38, the position of the bistou- 
ry in making an incision in the scalp for the application of the 
trephine, is certainly a novel one; so also of the position of the 
elevator, which by the by is a very queer one. Plate 48 we de- 
fy any one to recognize what is meant by the figures ; not even 
with the text can we comprehend the operation for fistula in and 
as there described. Finally, we have never known lithotomy 
performed, as a friend at our elbow remarked, without the pa- 
tient being properly secured ; we think in all instances he ought 
to be tied, except when the arms and hands are wanting, as is 
represented in plate 50. There are also many errors in num- 
bering not only the figures, but the plates. This necessarily 
produces great confusion and ought to have been carefully cor- 
rected. 

It is very evident that the author of this compilation, is not a 
practical man ; nor indeed can it be expected of one so much en- 
gaged in writing. On the very first page he commits himself 
He says nothing of patent lint, now so generally used, but speaks 
of charpie made by scraping fine linen rag with the back of a 
knife. Those who scrape lint will find it sufficiently slow in 
accumulating even by using the edge of the knife. Pessaries 
are made not only of ivory, wood and elastic gum, as stated in 
the text, but also of metal, glass, wool, &c. 

The instruments generally are badly selected; we must par- 
ticularize the amputating knife and saw. We cannot conceive 
how any one prefers the shape of the French to the English or 
American Instrument. Whoever has used one of Weiss' knives 
of English steel, will never go to Paris to look for a better, or if 
he does, will assuredly be disappointed ; and certainly every one 
must select the firm bladed saw with the teeth widely set apart, 
and not the bone-like saw of the French case. 

At page 159, we read, " The operation of trephining is requir- 
ed in simple fractures, with depression, on symptoms of com- 
pression continuing after depletion ; in compound fractures, with 
depression, unattended with symptoms of compression." We 
know not whether Dr. Doanc derived this last idea from Cutler, 
Hind or Blasius, (we know he did not from Vclpeau) ; but it is 
most assuredly at variance with modern experience in Surgery. 

No one has done more to simplify the instruments and opera- 
tions of Surgery than Lisfranc, yet his name is not mentioned in 
the whole work. 

Altogether, we apprehend this book has been gotten up more 
for effect than for practical utility. The plates are of little val- 



1830.] Extracts from the Note-book of a Physician, fyc. 299 

j — ■> 

ue, the figures arc unnecessarily multiplied. They arc both too 
numerous for the accompanying explanations, which are very 
unsatisfactory. 

Whatever may be the opinion expressed of the Surgery Illus- 
trated, and we assure its author it is given from honest motives, 
we cannot conclude this notice of it, without again commending 
the zeal and industry of Dr. Doane. His example, his great 
efforts to be useful, particularly to students of medicine and those 
unacquainted with foreign languages, ought to be imitated and 
deserves our thanks. P, F. E. 



Extracts from the Note-book of a Physician of this City, during 
his attendance on the Parisian Hospitals, 

LISFRANC'S CLINIQUE. 

Anatomy. — The vulva is sometimes found so very small that 
it is almost impossible to introduce a speculum. This does not, 
however, invariably indicate the same narrowness in the vagina, 
for it may be produced merely by the integuments of the perin- 
eum, extending higher up than they should. It would be advi- 
sable when women thus constituted become pregnant, to resort 
early, say the fourth or fifth month, (for earlier might cause a- 
bortion) to the slight operation of dividing this part of the perine- 
um, in order that it should not be torn too much during labour. 
If it be necessary to introduce the speculum, the incision should 
be performed without any fear, for the parts contain no blood 
vessels capable of affording a spoonful of blood. 

Ruysh mentions having sometimes seen the hymen double. M. 
Lisfranc says he saw one instance of the kind. The membrane 
is not, as is generally thought, very thin ; it is on the contrary 
nearly two lines thick, and as tough as leather. When imper- 
forate, it should be entirely removed, and a dilating pledget, or 
meche applied. 

In individuals arrived at the age of 40 or 50, and who have 
not cohabited for several years, the vagina becomes, as it were, 
atrophied, and as narrow as that of a virgin. The parts are then 
dry and hard; it is therefore necessary to be very cautious in 
such cases, not to introduce the speculum too large, nor with too 
much force and haste. 

Very corpulent females have their labia pudendi considerably 
thickened, and as this does not diminish during hbor, they can- 
not be completely effaced, and impede the exit of the child. 



STOO Extracts from the Note-book of a Physician, <£-c. [Oct. 

It is ridiculous to say that the nymphae are destined to direct 
the flow of urine. It is evident that their office is to afford ma- 
terials for dilatation during labor. As they are in some measure 
connected with the clitoris, it may be that they enhance the ve- 
nereal orgasm during coitus, and thereby tend lo insure impreg- 
nation. 

It has been lately proposed, in cases of rupture of the perineum 
during labor, to make, previous to the sutures usually practised, 
an incision on each side and at a small distance from the rupture, 
so that the contact of the torn surfaces may be facilitated. 

In women habituated to coitus, the uterus is not beyond the 
vagina, but actually projects in it. There is an erectile tissue 
in the perineum, which assumes the appearance of a tumour 
when efforts at stool are made. The direction of the pudic ar- 
tery should be carefully studied, for its course is very different in 
females from what is seen in males. The vagina is generally 
longer in tall women than in those of small stature. The pubes 
are more prominent in southern than in northern females ; and it 
will probably be found that the pelvis is also deeper and the va- 
gina higher in southern women. 

The attachment of the vagina to the cervix uteri, is six and a 
half lines thick anteriorly, and seven and a half lines posteriorly, 
so that the amputation of the cervix may be carried much high- 
er up without injury to the peritoneum than is generally thought. 

Introduction of the Speculum Uteri. — For the introduc- 
tion of the Speculum, the patient should be placed in the same 
position as if she were to undergo the operation of Lithotomy, 
save that her hands are not to be fastened to her feet, nor any 
ligatures applied. The legs, or rather knees, arc to be held by 
two aids if admissible ; if not, the feet must rest on chairs of an 
equal height with the bed. The back must be horizontal, and 
but a small pillow placed under the head. The size of the spe- 
culum used should be proportioned to the dimensions of the va- 
gina ; this may be judged of from the length of the vulva, for the 
vagina is generally proportioned accordingly. M. Lisfranc 
mentions a case in which the vulva was only an inch in length, but 
very dilatable. The extent of the perineum varies exceedingly 
in different individuals, and Mr. L. has seen it occasionally two 
and a half inches. The labia? are to be separated with the lin- 
gers of the left hand, and the speculum, previously smeared with 
sweet oil, gently introduced with the right hand according to the 
axis of the vagina. As soon as the instrument has passed the 
external orifice, the labia arc to be left to themselves, otherwise, 
the dilatation of the vagina would be impeded. The speculum 
should be urged forward with the utmost caution, lest, by sud- 
denly overcoming some slight opposition, the instrument be for- 
pibly thrust against the os tinea:. The eye should be kept as 



183C] Extracts from the Note-book of a Physician, <J-c. 301 

much as possible in the speculum, in order to detect any devia- 
tion from the axis of the parts, and to engage the os tinea? in its 
extremity. This last part of the operation is not always free of 
difficulty, for the os tincae is scarcely ever in its natural position, 
especially in females who have indulged much in sexual inter- 
course. It is generally turned downwards and backwards; 
hence it is necessary always to touch, before introducing the 
speculum, in order to ascertain the exact state of the parts. — 
This, however, should be done very gently, for fear of causing 
a discharge of blood from any diseased surface that might chance 
to exist, and thereby prevent the possibility of seeing. Care 
should be taken not to mistake mere folds of the paricties of the 
vagina for the uterine orifice, for this is often remarkably well 
imitated, and the parts might be pronounced healthy, when in 
fact they were not seen. It is in such cases that a long specu- 
lum, and one made so as to open, becomes very useful, for by 
pressing up a little firmly, the fold may be removed, or this may 
be done by gently opening the instrument. The os tinea? being 
exposed should be carefully and very gently wiped of its mucus 
gr other discharges, by the aid of a kind of brush made with rav- 
elled linen. A candle, of course, must be used; it is held in front 
of the speculum, so that the rays of light may be directed to the 
« »s tincae. If the uterus be high up, it may be lowered very con- 
siderably, by telling the patient to bear down as if at stool. The 
rectum should have been previously evacuated by an enema. — 
Look at the ulcerations as obliquely as possible, in order to judge 
correctly of their depth * 

General Symptoms of Uterine Disease. — The symptoms 
that should lead to suspect the existence of disease of the uterus 
are: pains or twistings of the stomach, unattended with other in- 
dications of gastric affection, and especially if they have resisted 
the antiphlogistic treatment, whether there be uterine pain or not; 
gastro-cnteritis resisting ordinary means: increase of the mamma?, 
or else pain with or without this increase, during the interval of the 
menstrual periods, are almost positive indications; ptvalLsm with- 
out pregnancy : heaviness or pains about the loins or pelvis, whe- 
ther occasioned or not by walking, riding, a false-step. &c, during 
the intervals of menstruation; pains in the inguinal region, or 
spleen, without increased size of this organ ; pain solely in the 
rectum, or at the umbilicus, or along the sciatic nerve in the thigh, 
without any other symptom of disease ; sensation of internal 
hoemorrhoids; painful coitus always indicates at least inflamma- 
tion of the os tinea-, and will then yield to rest and narcotics; ob- 
stinate palpitations; uterine hc&morrhage as surely indicates a 



* [Wo intend in our next number to make some remarks on this subject, 
syhich the want of space forbids in the present. — Eds. | 



302 Extracts from the Note-book of a Physician, fyc. [Oct. 

diseased state or morbid tendency in the uterus, as hcemoptysis 
does that of the lungs; discharges per vaginam. 

Particular attention should be paid to the insidious march of 
some cases, which suddenly take off the patient when least ex- 
pected. In some cases the pains cease entirely a few weeks pre- 
vious to death, so as to induce the patient to think herself cured, 
but this relief is suddenly interrupted, by hemorrhage, diarrhoea, 
or stupor, the most excrutiating pains and death. The disease 
may run through all its stages without the knowledge of the pa- 
tient, so slightly is the system affected in some instances. Dis- 
charges long continued may cause cancer, as well as pulmonary 
catarrh does tubercles. 

Cases of Uterine Disease Examined with the Speculum. — 

M. Lisfranc exhibited to-day the diseased uteri under his charge, 
by means of the speculum. I examined sixteen cases, and was, 
as usual, surprised to find the affections apparently so slight. — 
The great majority of them appeared to be merely hypertrophy 
and a little redness ; generally a whitish and thick discharge from 
the orifice ; in a few cases the red surface seemed to be excoria- 
ted, in others strewed with small vesicles; I could discover true 
ulcerations in no case, although Mr. L. mentioned it to exist in 
several. It seems to me that he must confound excoriation with 
ulceration. Among the cases, was that of a female, whose os 
tineas was amputated by Mr. L. three years ago; the cicatrix 
is quite visible and the parts healthy. The patient is here for 
tubercles of the lungs. 

Diseases of the Uterus. — The diseases to which the uterus 
is subject, may be enumerated as follows: — 1st. Chronic inflam- 
mation either of the body or neck of the organ, or of both, or 
parts of both ; it is always attended with hypertrophy, and then 
the tissue resembles that of the womb during pregnancy — hy- 
pertrophy may be considered the first step of inflammation of 
this organ, whether acute or chronic. It must be remembered 
that there is here no transformation of tissue. 

2d. Transformation of the tissue, which becomes white, but 
not schirrous. It is the same condition as that often observed 
in mammas, and which may be made to disappear entirely by 
compression, as practised by Kecamier; this process will never 
dissipate a schirrus of the mamma. It occasions pains similar to 
those of a schirrus, but these occur very early, which is not the 
case with schirrus. 

3rd. Schirrous stale of any part, or of the totality of the womb, 
should be distinguished from ossification, or from calculi situated 
in its substance, &c. 

4th. Tumours occurring on the surface of the uterus — Mr. 
L. relates a case in which the uterus presented three firm bodies, 



1836.] Extracts from the Note-hook of a Physician, $*c. 303 

similar to cocks' spurs. Tumours of the uterus should be dis- 
tinguished from those not attached to, but merely situated in the 
vicinity of the uterus. Mr. L. has dissected eight cases pre- 
senting tumours near the uterus, and in every instance the neck 
of the uterus was thrown up so as to lodge behind the pubis, and 
the body of the uterus pressed downwards in the pelvis. It 
seems that tumours of the uterus have a tendency to project out 
of the pelvis, and that those in the neighbourhood, on the contra- 
ry, always press on the uterus and till the pelvis before they 
leave it. 

5th. Simple ulceration of the os tineas. 

6th. Small polypi of the os tincae. 

7th. Carcinomatous ulceration. 

8th. Fungus of the os tineas ; this is not the fungus hematodes ; 
it may occupy the vagina; is not ulcerated, but soft, spongy; 
furnishes a sero-mucous discharge in great abundance ; the tu- 
mour is very easily torn with the finger, and by pressure a fluid 
may be obtained similar to that just mentioned. 

Chronic Metritis, or simple Hypertrophy of the Ute- 
ri's. — Chronic Metritis, or simple Hypertrophy of the Uterus or 
of any of its parts, unconnected with any degree of ulceration. 
It is more common in the body of the uterus than in its Cervix, 
and is generally very insidious in its progress, especially about 
the critical age. It should then be termed latent metritis. The 
hypertrophy is sometimes carried so far as to give the uterus the 
size of the head of a six months foetus. This is not the kind of 
enlargement caused by the production of a white tissue, resem- 
bling the schirrous, though very 'different from it ; but it is a mere 
increase of healthy tissue, and therefore should be distinguished 
from all others, as being much more readily cured. In simple 
hypertrophy; touching is always a painful operation, and the 
consistence of the uterus is found normal, though rather soft; 
To the feel it gives the same impression as an uterus in early 
pregnancy, or shortly after abortion. 

Treatment. — Absolute rest is among the most influential 
means, and one, without the strictest observance of which, it will 
ever be impossible to effect a cure. The patient should not even 
walk from h et bed to the sofa, nor even move about roughly in 
her bed. She must be carried to her sofa, if she wishes to occu- 
py it during the day. These precautions are recommended in 
order to prevent the irritation kept up by the friction of the ute- 
rus against the adjoining parts, whenever the patient makes the 
least motion. (Is this friction really produced, as Mr. L. be- 
lieves, by ordinary movements?) Abstinence from venereal 
gratification is also absolutely necessary. Small quantities of 
blood should be daily taken from the arm, as long as the patient's 
state will permit By commencing with only 4 ounces, or even 



304 Extracts from the Note-book of a Physician, §c. [Oct; 

less, according to circumstances, a spoonful if no more, it may 
be continued for some time. It is here desired to obtain the re- 
vulsive effects of the remedy, and these effects are much more 
marked than is generally admitted. For instance, it is a certain 
fact that leeches applied repeatedly and in large numbers to the 
mamma, often occasion puenmonia, by calling the blood to the 
chest. Again, it is very dangerous to continue the application 
of leeches to the arms or chest, in individuals predisposed to ap- 
oplexy, for in such cases, the disease will often be occasioned. 
Mr. L. never applies leeches to the pelvic region, except in some 
cases of chronic induration of the uterus, when it may be desir- 
able to increase the action of the parts diseased, in order to dis- 
cuss the induration. It is impossible to determine a priori, how 
much blood a woman may safely lose. This must be decided by 
careful proceedings, and regulated accordingly. If the nervous 
system be found to suffer, resort to antispasmodics. Baths made 
merely tepid, and often used, are very serviceable, unless there be 
hemorrhage. Baths of the pelvic region only, should never be 
employed. Tepid enemata are often very useful, as it is by no 
means uncommon for persons in this state to be costive, and the 
collection of foeces can be but a source of irritation. The baths 
and clysters are recommended merely tepid, in order to produce 
as little excitement of the organs as possible. Injections per va- 
ginam, also tepid, are very useful ; should be made three times 
a day, and the position be such as to retain the injection in the 
vagina at least fifteen minutes. One s}Tinge full should always 
be used for cleansing the parts, before the other be permitted to 
remain. The introduction of cataplasms is filthy, disagreeable, 
and more irritating than the kind of fomentation with mucilage 
of flax-seed just directed. The injection should be made by 
means of an elastic and small canula, which should be introduced 
with caution, so as notrto wound the diseased parts. 

Chronic Metritis, when slight and without pains, or merely 
such as are intermittent, should be treated by revulsives to the 
pelvis, as dry cups, moxas, blisters, issues, &c. Regimen should 
be low, and strictly observed, for this is absolutely necessary to 
ensure recovery ; no coffee, but mild vegetables, milk, &c. The 
quantity of food should be gradually diminished to one-half that 
\\sca\ in health. Idiosyncrasy should never be overlooked in the 
regulation of the quantity,as well as quality, of food to be taken; 
when vegetables disagree, let them bc.dressed with chicken juice, 
fish, and white flesh. Walking should be carefully avoided as 
long as ii causes the slightesl pain about the affected region, Un- 
less it he absolutely necessary to the healthy performance of 
digestion, or i<> the' amelioration of the nervous system ; at the 
menstrual period, the patient, however, should always take more 
or less exercise on fool. The state of the digestion and of the ali- 
mentary canal should be very strictly attended to, for when dis- 



183G.] Extracts from the Note-book of a Physician, §c. 306 

cases of the uterus become complicated with an affection of the 
digestive tube, the chance of success is very much diminished. 
Leeches may, sometimes, be applied to the os tinea;, when the 
case is positively ascertained to be merely hypertrophy, without 
schirrus ; and then, with the intention to stimulate the vessels, 
and thereby bring about the removal of superfluous matter. If 
the case be schirrus, there is great danger of producing as many 
carcinomatous ulcerations as there arc leech bites, as has been 
repeatedly seen in cases of schirrous mamma. Frictions with 
Iodine may be useful ; the " Douches de Vagin" are highly ben- 
eficial, as are also those of the uterus. They may be made sul- 
phurous when there are also discharges. They should be con- 
tinued at first about five minutes, and the length of time gradu- 
ally increased. They are administered by means of a tube 
communicating at one end with the vagina or uterus, and at the 
other with a reservoir of water, placed in an elevated position ; 
the atmospheric pressure throws in the water with considerable 
force. 

IlYrERTRoniY of the Uterus, with transformation of 
tissue. — The increased size of the uterus does not always ne- 
cessarily indicate a schirrous state, for there may be simple hy- 
pertrophy without alteration of tissue, or else hypertrophy with 
transformation of tissue. This kind of hypertrophy may be 
compared to the state of the mamma when said to be "engorge." 
It is characterized by the almost total absence of pain ; the ra- 
pidity of its progress; it very soon becomes chronic; does not 
yield as readily to remedies as cases of simple hypertrophy. — 
The antiphlogistics should not be carried too far, for the disease 
continues acute but a very short time. An excellent remedy is 
compression, applied by the use of the pessary, of the shape of a 
"bilboquct;" this instrument being well placed, the uterus, by its 
tendency to descend, especially whenever the patient moves, 
takes exercise, or goes to stool, is pressed against it, and thus 
produces the effect desired. The pessary is to be removed when- 
ever it occasions the least pain, and reapplied when the irrita- 
tion has ceased. It may be left applied or not during menstrua- 
tion, according to circumstances, for it often happens that the 
uterus at this period is sensitive and necessitates its removal. 
Injections should be continued, and cleanliness strictly attended to. 

Tumours of the Uterus. — These should be treated pretty 
much as the preceding diseases, viz: by ant iplogistics, regimen, 
rest, abstinence from coition, &c By such means, the progress 
of many very voluminous tumours, although of a schirrous na- 
ture, may be arrested, and the patient permitted to live a great 
number of years, especially if she attend strictly to the reduction 
of every symptom of irritation that may return 

39 



306 Extracts from the Note-book of a Physician, fyc. [Oct. 

Milliary Folypi of the Os TiNCiE. — Milliary Polypi about 
the os tinea?, cither on the internal or external surface of its lips, 
frequently exist and pass unnoticed for want of careful examina- 
tion. They are extremely small, semi-transparent, not very 
hard, roll under the finger, and do not increase in size. The 
pain is excessive and similar to that of cancer ; no hemorrhage ; 
no enlargement ; irregular menstruation ; such are the ordinary 
symptoms. These increase and are attended with emaciation, 
diarrhoea, and even death. If situated externally, they may be 
readily seen ; but if within the orifice, the finger must be intro- 
duced in order to feel them, or the double branched speculum 
used so as to permit the orifice to be opened and inspected by 
the eye. Unless the physician be very particular, he may not 
notice them, so small and unimportant do they seem. The treat- 
ment consists in taking hold of them with a pair of forceps and 
twisting them off. Should they return, cauterize with nit. ar- 
gent, after their removal. It is worthy of notice that the pain 
ceases at the instant they are extirpated, and returns no more. 
This operation should be followed by antiphlogistics and such 
diet as will prevent imflammation of the parts, also cleanliness. 

Tubercles of the Uterus. — Tubercles may exist in the pa- 
rietes of the uterus and also in the cervix. Lasnnec has an excel- 
lent article on the subject in the great Diet, des Sciences Med- 
icales. M. Lisfranc says he first detected them in the mamma?. 
The inflammation of uterine tubercles, may be prevented by 
proper means. It may remain latent, and then become cither 
acute or chronic. The tumour produced, may be easily mista- 
ken for hypertrophy with white tissue, or for schirrus ; but its 
progress will evince its nature, for, according to the intensity of 
the inflammation, it will assume either the form of a cold or a 
warm abscess, suppurate, and discharge the kind of matter pecu- 
liar to such tumours. The nature of the discharge will prevent 
its being mistaken for an ulcerated carcinoma, as it is very dif- 
ferent from the ichor of the latter ; is whitish, cheesy, ("caseeusc") 
floculent, (floconneux,) as is the case with suppurating tubercles 
of any other part of the body. By pressing the cervix uteri, 
this peculiar matter is sometimes abundantly discharged. In 
carcinoma we sec ulcerations simply ; but here an abscess. Ex- 
tirpation is necessary in cases of carcinoma, whereas tubercles 
may be cured without, as is often seen in cases of tubercular 
testicles. The proper remedies are antiphlogistics, baths, injec- 
tions with infusion or decoction of bark, the chlorides, &c. — 
The granulations should be touched with the " proio-nitraie- 
acidc liquids de mercure" Rest and abstinence from venery, are 
absolutely necessary. It is perhaps impossible to establish pos- 
itively the diagnosis before suppuration takes place, hence tu- 
mours of the womb should always be suspected to be of this na- 



1830.] Extracts from the Note-hook of a Physic urn, $c. 307 

turc, and treated accordingly. The abscess may open into the 
vagina, rectum, perineum, &c, and produce more or less mis- 
chief. When long continued, these ulcerations may degenerate 
and become carcinomatous. 

Ulcerations of the Os Tinc^e. — The simple ulceration of 
the mouth of the uterus is generally difficult to cure, even when 
unattended with loss of substance. This may be owing to the 
peculiar nature of the uterine tissue, and also to the irritation 
kept up by the continual friction of these parts, at every motion 
of the body, especially walking and riding. The irritating qual- 
ity of the matter secreted by these ulcerations, may, by coition, 
communicate to the man a species of gonorrhoea. These ulcera- 
tions may eventually become carcinomatous. 

Simple ulceration of the cervix is most frequently met with in 
females from 20 to 35 years of age, and not, as some have thought, 
at the critical age. This may be accounted for by the increased 
action of the parts at this age, for excesses of venery, and preg- 
nancy, are more common at this than at the age of 45 or 50. — 
Whenever a female complains of discharges from the vagina, 
suspect ulcerations or redness of the os tinea? ; the slight degree 
of redness very frequently observed, is not of much importance, 
and should not be confounded with ulcerations. It is true, how- 
ever, that when neglected, this redness often passes to the state 
of ulceration. 

The posterior lip of the os tincse is much more commonly af- 
fected than the anterior ; perhaps because it is more exposed to 
the action of the acrid humours which pass from the uterus and 
collect in the most dependant parts of the vagina. This affec- 
tion consists, in the first stage, of a merely denuded surface, which, 
when exposed to the air, appears free of any discharge ; at the 
second stage, a bloody fluid is discharged when the part is ex- 
posed to the air by the speculum, or wiped with a soft lint brush. 
By a side view, a slight loss of substance may be perceived, but 
it is as yet extremely superficial, and seems scarcely to penetrate 
beyond the external membrane. In the third stage, the ulcera- 
tions arc much more evident, and true ulcerative granulations, 
("bourgeons charnus?) as well as slight vegetations, may be seen. 
The parts increase in size, become softened, are easily torn by 
the least violence, feel soft to the touch, and soon degenerate 
into complete carcinoma. It may, however, advance very far 
without partaking of the cancerous nature, and this will always 
be detected by the kind of discharge, which, if there be no can- 
cer, is rather of a mucilaginous (glaireux) nature, than of that 
of ichor. 

Simple ulceration produces nearly all the symptoms of can- 
cer; it causes as much constitutional disorder, and often death. — 
The paia is excessive, the discharge sometimes profuse r and often 



308 Extracts from the Note-book of a Physician, fyc. [Oct. 

has the peculiar odour of that produced by cancer ; the consti- 
tution undergoes that change called a cancerous diathesis. The 
increase of pain during the progress of treatment, should not 
always cause alarm, for this is often the case when the disease is 
fast yielding, and has, in fact, nearly disappeared. Instance a 
patient completely cured a year ago by amputation, but who 
still suffers very much. Are these dependant on habit ? In this 
affection, the cervix is almost always found inclined strongly 
towards the rectum, and, in many cases, the patients complain 
more of the rectum than of the uterus. These ulcerations may 
complicate all kinds of hypertrophy ; they may be stationary — 
change places, or extend to the entire uterus, its attachments, &c. 

Strict attention to regimen and rest, is absolutely necessary. 
Cauterization may prove fatal when carelessly employed; but, 
otherwise, it can be considered perfectly innocent and free of 
danger. First abate the irritation or inflammation, in order to 
prevent metritis from supervening. Never cauterize when there 
is pain, but then order baths, emollients, low diet, and even ven- 
esection if necessary. The caustic should never be used when 
the ulceration is combined with tumefaction, (engorgement]) but 
act as if this existed without ulceration ; order emollient injec- 
tions and antiphlogistics. Hypertrophy of the os tineas, compli- 
cating ulceration, should counter-indicate the use of caustic. In 
order to apply the caustic, the speculum should be used, and the 
cervix alone included in it. If this cannot be sufficiently well 
done by the instrument alone, small pledgets of lint should be 
wedged in between the os tinea; and end of the speculum, so as 
to isolate this part from the vagina, and thereby prevent the ac- 
tion of the caustic from spreading too far. This being done, 
wipe the os tinea? clean, with a small lint brush, in order to re- 
move the mucus which might prevent the action of the applica- 
tion; touch wilh the caustic very lightly and repeatedly ; but 
only in a small surface. This remedy acts by changing the na- 
ture of the diseased action. After cauterization, the parts should 
be well washed by injections, to prevent too much action. The 
cauterization should be repeated every six or eight days, unless 
circumstances prevent. The disease is sometimes aggravated; 
then cease its use. It may be applied advantageously even in 
cases of mere redness. 

Injections of diluted chloride of soda, decoction of cinchona, 
cau de Barrrgc, and douches, may be used for months, either with 
or without the assistance of cauterization. The engorgement of 
the ovaries, when chronic, is not an objection to cauterization. — 
The proto-nitrate-a.c'uh liquide de mercure, may not unfrequent- 
ly be substituted with advantage for the lunar caustic. 

Diseases of the uterus are extremely liable to return after ha- 
ving been cured ; hence the necessity of attending particularly 
to the state of the menses ; resort to venesection whenever they 



183G.] Extracts from the Note-book of a Physician, tyc. 309 

are disturbed. The continuance or return of pain after cessa- 
tion for some time, is not always a symptom of a return of dis- 
ease, but is often nervous, and will yield to narcotics. When 
the ulceration, however simple, continues to spread, notwith- 
standing the use of these means, and produces or threatens great 
constitutional disorder, amputation should be resorted to, for 
otherwise death may be occasioned. Why not amputate the 
os tineas as well as a limb, when its diseased state affects the 
general system and threatens life ? 

Leucorriicea. — M. Lisfranc considers leucorrhcea sometimes 
an endemic affection, or dependant on atmospheric influence, 
(constitution medicate). It is very often occasioned by the use 
of foot-stoves, (chauffrettes) so common in this country; by a 
humid season; occasionally by excessive venery; sedentary ha- 
bits, especially if warm chairs are used; but perhaps the influ- 
ence of hot climates tends more to produce it than any other 
'known cause. The discharge may proceed either from the va- 
gina or from the uterus, or at the same time from both. Chronic 
inflammation of the vagina may gradually extend to the uterus, 
and, if neglected, may give rise to a schirrous condition, polypi. 
&c. It should be borne in mind, that w 7 hen these discharges have 
•long continued, they are true emunctories, and must therefore 
not be suddenly suppressed. The organs of the chest should al- 
ways be carefully explored previous to arresting this discharge, 
for Mr. Lisfranc has known this neglect prove fatal to a great 
number of females, whose lungs, being tubercular, ulcerated very 
rapidly after the successful treatment of Leucorrhcea. It will, 
when the lungs are the least suspected, be prudent to establish 
-setons or issues previous to such suppression. The general 
state of the system should be attended to, and tonics or antiphlo- 
grstics used accordingly. The use of the speculum will decide 
whether the discharge be from the vagina or uterus If from the 
vagina, Mr. L. has used the " Potion de Chopart," (a mixture of 
Bals. Copaiba, Spirits ^Ether, Nit. &c.,) or Bals. Copaiba and 
opium internally or by enemata. The doses should be gra- 
dually increased until either costiveness or diarrhoea be produced. 
The opium may be carried to six grains daily, with advantage. 
Injections of claret and w r atcr, gradually made stronger, and even 
carried to pure wine ; rose water; sulphate of zinc, &c &c. — 
Injections of chloride of soda, (diluted.) very rarely fail to arrest 
it; their strength should be gradually increased. The posi- 
tion of the patient's pelvis should be such as to retain the injection 
in the vagina, at least ten or fifteen minutes, and thereby render 
the injection rather a hath than a lotion. This injection cannot 
be used for men, because of its liability to cause false membranes 
to be formed in the urethra, and consequently strictures. This 
objection might, in some cases, be obviated by the introduction of 
a bougie immediately after the injection. 



310 Extracts from the Note-book of a PJiysician, fyc. [Oct. 

When the discharge proceeds from the uterus, its suppression 
is more difficult to obtain. After the flow of the usual menstru- 
al fluid, there sometimes succeeds one of a serous nature, almost 
limpid, and so abundant that it soaks through thick folds of linen, 
and even leads some to believe themselves affected with inconti- 
nence of urine, or dropsy of the uterus. This flow, in some ca- 
ses, appears but a few days after the cessation of the menses, and 
continues a week more or less. The discharge may be thick, 
opaque, acrid, &c. Here also the general state of the system is 
to be carefully attended to, and prepared for the injections. If 
these, made in the vagina alone, will not suffice, they should be 
carried directly into the uterus, by means of a catheter intro- 
duced into the orifice of this organ. This may be done without 
the least pain, as was proved by Mad. Lachapelle, Mr. Dume- 
ril, &c. Emollient injections should be tried before resorting to 
those of an astringent nature. The decoctions of Elder flowers, 
and Marsh mallow roots, are very good. It is necessary, during 
the treatment of these discharges, to abstain from coitus. When 
using the astringent injection, beware of metritis ; watch the 
whole system. 

On Amputation of the Os Tinc^. — M. Lisfranc has just re- 
lieved a female of the most troublesome palpitations, by the am- 
putation of an ulcerated os tincoe. 

It is wrong, he says, to think that the neck of the uterus should 
be amputated, only when it is the seat of a cancer. Certainly 
no one would hesitate to take off* a leg or arm, if either were 
occupied by an ulcer of such a nature as to seriously in- 
jure the whole system ; he does not see why the same rule 
should not be applied to this organ. It must therefore be borne 
in mind, that whenever the ulceration covers the whole os tincoe, 
and threatens to spread to the vagina, no time is to be lost, else 
the disease will rapidly degenerate into- cancer, and probably 
render an operation impossible, by extending to the body of the 
uterus. When the neck of the uterus is very short, as is seen 
occasionally, the danger of the body of the uterus becoming dis- 
eased, is very great. We should never be frightened by the 
phantom of " cancerous diathesis," for it is impossible to say 
positively that it exists, until the patient is nearly exhausted. — 
Moreover, the books are full of cases in which Extirpation has 
proved successful, when there was every reason to believe in the 
existence of the diathesis. 

M. Lisfranc has now [1830,] amputated the os tinea? about 
sixty-five times, and lost but very few patients ; the cicatrix is 
generally complete in from four to six weeks. 

Treatment after Amputation of the Os Tincoe. — I wit- 
nessed this operation performed the day before yesterday, by M. 
Lisfranc. The patient (".'meed no pain, and indeed remarked 



1836.] Extracts from the Note-book of a Physician, tyc. 311 

that she had experienced none whatever at the moment of the 
excision. Mr. L. observed, that the uterus resembled, in this 
respect, the liver, testicle, <fec.; that it was insensible to the ac- 
tion of the knife — whilst compression, or torsion, produced intense 
pain. Mr. L. takes occasion to make the following remarks. 

" The patient has, since the operation, been affected with vom- 
iting, syncope, nervous tremors, and even spasms. The sangu- 
ineous discharge from the wound has not been sufficiently great 
to occasion these symptoms, and they should be attributed to the 
shock of the nervous system. They should excite no alarm, 
being usual after this operation. The vomiting continued until 
this morning ; there is some epigastric tenderness, probably ner- 
vous ; her courage, so remarkable on the day of the operation, 
has entirely vanished, and she now believes herself doomed to 
die. Narcotic and antispasmodic enemata have been adminis- 
tered ; leeches have been applied to the abdomen, it being pain- 
ful on pressure. I never dread the haemorrhage, unless it be 
very great, for it tends to relieve the organ, and to prevent the 
development of too much inflammation. Narcotics (opium) 
should always be administered, when the pulse is sufficiently 
strong to bear them, for if it were very feeble, they would be 
dangerous. They should be given in enemata, in order to spare 
the stomach, which is then so irritable as scarcely to retain gum 
water. If the habit be plethoric, take blood from the arm. — 
Should the hemorrhage become too abundant, the tampon must 
be resorted to, and applied near the orifice of the vagina, in or- 
der to avoid irritating the wounded surface by its contact. In 
twelve or twenty-four hours, at most, remove the tampon and 
coagula with the finger, for were they to remain longer, decom- 
position would begin and cause serious irritation. I have been 
obliged to resort to the tampon but six times in sixty operations. 
There are usually pains in the abdomen and about the pelvis 
three or four days after the operation ; venesection should then 
be practised, if the pulse will permit, and the vagina be well 
bathed with emollient fluids. Rest and abstinence are strictly 
to be enjoined. In about a fortnight, the uterus should be exam- 
ined, and the granulations cauterized with nit. argent., after 
which, injections with tepid solution of mur. soda, will hasten 
the cure. The cicatrix being complete, attention should be di- 
rected to the causes which produced the disease — the menses 
should be restored ; &c. 

"Females frequently complain that the disease is returning; a 
careful examination will then generally prove that the pains, &c, 
they experience, are merely nervous, and will readily yield to a 
little opium. " 

Amputation of Carcinomatous Os Tincs. — "The patient in 
question is thirty years of age. of a lymphatico-sanguine tamper- 



312 Extracts from the Note-hook of a Physician, fyc. [Oct. 

ament, is feeble, emaciated, dry ; her flesh feels flaccid ; no part 
of her system, save her uterus, appears to be affected. It is an 
erroneous opinion, entertained by many authors, that whenever 
the neck of the uterus is seriously diseased, the other parts of the 
body must suffer. From the present condition of the patient, 
and the influence exercised by the uterine tumour on her system, 
I am confident, that if left to nature, she must die in six weeks. 
We should therefore operate, even were the cancer to extend be- 
yond the neck of the uterus, to the parietes of the vagina ; nay, 
were we compelled to remove a portion of the peritoneum. — 
Ambrose Pare and others, have successfully removed the entire 
uterus; why should I not remove one-half of it ? Mr. Blundel, 
of London, assured me he had several times removed the whole 
with complete success." 

Having premised these observations, M. Lisfranc proceeded 
to the operation. The carcinoma being too voluminous to per- 
mit advantageously the use of the speculum, this was dispensed 
with, and the mass seized with a pair of hook-forceps, (erignes,) 
in order to draw it near the os externum. The tumour was, 
however, so soft, that the forceps repeatedly tore their way out ; 
he was then obliged to place the hooks at the junction of the dis- 
eased and healthy parts. Having thus seized it with a number 
of these forceps, and placed some of them in the hands of assis- 
tants, very gradual traction was made until the tumour was 
brought to view. The disease was then perceived to occupy, 
not only the cervix, but also the superior and posterior portions 
of the vagina. The whole was removed, consisting of a circular 
bit of the mucous membrane of the vagina, about two inches in 
diameter, with. the os tinea? in the centre. The vagina was im- 
mediately and carefully filled with lint, in order to arrest and pre- 
vent hoomorrhage, and the patient put to bed. She appeared to 
suffer extremely during the traction necessary to bring down the 
tumour, but not so much whilst under the action of the knife. — 
She was much agitated for two or three hours after the operation ; 
when nausea and nervous tremors supervened. M. Lisfranc 
then saw her, but did not consider these symptoms alarming. — 
She was very soon after taken with violent convulsions and ex- 
pired. 

The autopsic examination threw no light on the cause of the 
event ; a very small coagulum was found, on removing the tam- 
pon ; no organic lesion detected. M. Lisfranc considers her 
death occasioned by the spasms alone, and observes that the is- 
sue could not have been foreseen, and may happen when least 
expected. lie feels perfectly justified in having performed the 
operation, and would not hesitate to repeat it, under similar cir- 
cumstances. 



.1830.] American Journal of Medical Sciences. 313 

Part III— MONTHLY PERISCOPE. 
American Journal of Medical Sciences. 

In the commencement of our editorial labors, we disclaimed 
all unfriendly feelings toward our co-temporaries, and declared 
our design and desire to bo harmonious co-operators to achieve 
the same great and desirable object, the improvement of medi- 
cine. We were sincere in our professions, and if we entertained 
more regard for one than the rest, it was for the American Jour* 
nal of Medical Sciences. We have been pleased to extract free- 
ly from its valuable pages and give it full credit for all we re- 
ceived. 

It is true, had we vanity enough to constitute ourselves liter- 
ary censors, or had we been disposed to endeavor to enhance our 
own consequence by exposing the defects and faults of others, 
we might have found something to condemn, notwithstanding the 
editor's great experience ; but always despising that ignoble spirit 
that delights in disparaging and speaking ill of others, we pre- 
ferred rather to contemplate the useful and interesting matter 
contained in his numbers and select therefrom for the benefit of our 
readers. We were not disposed to quarrel with him for loving his 
friends and neighbors to excess, and pushing the puffing system 
beyond the bounds of discretion, or because he sometimes seem- 
ed to run aground in his panegyrics and be entirely at a loss for 
new modes and forms of eulogy — this we regarded as an amia- 
ble weakness — and few, alas, err on the side of amiability ! 

But we were not a little surprised to see the following ill- 
natured and illiberal criticism of the Southern Medical and Sur- 
gical Journal among his bibliographical notices. 

"Art. XXII. The Southern Medical and Surgical Journal. — Edited by 
Milton Antony, M. D. Professor of Obstetrics in the Medical College 
of Georgia, and Joseph A. Eve, M. D., Professor of Therapeutics and 
Materia Medica in the Medical College of Georgia. 

Tins is another new candidate for public favor. It is to be published 
nioul lily al Augusta, Georgia, and the first number was issued in June last. 
Ii is divided into three departments, viz: 1. Original Communications.— 
2. Reviews and Selections. — 3. Periscope. Each number is to contain 64 
pages, and seven numbers will comprise about as much matter as one of this 
journal. The price is five dollars per annum. 

In the June number, the only one that has reached us, there are two or 
three interesting original articles, which we shall notice particularly hereaf- 
ter. The reviews are meagre and manifestly from inexperienced hands; 
the selections are for the most part interesting. 

It has been considered the high prerogative of literary and sci- 

40 



314 Acetas Plumb i in Cholera. [Oct, 

entific men, to occupy a glorious pre-eminence, far above and 
unaffected by the low strifes and petty animosities that agitate 
vulgar minds, and even to maintain inviolate the strictest bonds- 
of friendship and the most harmonious intercourse, whilst their 
respective nations have been engaged in all the horrors of war. 
But the conduct of our brother of the American Journal, cer- 
tainly seems to savour of a participation in those sentiments of 
jealousy and unkindness, unfortunately too generally felt and 
cherished between the North and South of our own country. 

What could be more ungenerous than such an attempt, by one 
who enjoys so full a tide of editorial prosperity, to crush others 
who though confessedly inexperienced, honestly aim to do well? 
Would it not have been more charitable in him to have waited 
at least until we had tried our " hands" a little longer before he 
indulged in quite so much severity towards us? 

Relying on the intelligence and magnanimity of our profession- 
al brethren, to whose judgment we are willing f o submit, we 
would have passed this invidious and unmanly attack with the 
silence it deserves, but we thought it proper to correct a false 
statement which might perhaps, as it was doubtless intended, mil- 
itate somewhat against us, as the American Journal has an ex- 
tensive circulation at the South. He says seven of our numbers 
will comprise about as much matter as one of the American 
Journal, and the price is the same: As the latter is published 
quarterly and the former monthly, it ought of course to com- 
prise three times as much — the number of the American Jour- 
nal that contains this dignified criticism, comprises 260 pages* 
exclusive of table of contents, list of callaborators, advertise- 
ments, &c. which are not included in the 64 of our monthly num- 
bers — whereas to be equal to seven of ours it should embrace 448 
(7 times 64). There is certainly some difference between 260 
and 448. The present number of the American Journal is about 
equal to 4, instead of 7, of our numbers — and we are warranted 
by the encouraging increase of our subscribers and contributors 
to hope, that before the Southern Medical and Surgical Journal 
has been published as long as the American Journal, we shall be 
able to extend its magnitude considerably without farther ex- 
pense to our readers. 

In conclusion we say to the editor of the American Journal, 
he has been disposed to show no courtesy and we ask of him no 
favour — we take his Journal and we will make the best use we 
can of it, but will always give him credit for all w r e take — it is 
well worth $5 — it is well supported by able collaborators — and 
is certainly, after making all deductions, a very respectable and 
useful Journal. 



Acetas Plumbiin Cholera. — Dr. Graves of Dublin has for some 
years used the Acetas Plumbi in cases of Cholera, with such sue* 



183G.] Acelas Plumbi in Cholera* 315 

cess as enables him to say, that in all cases where there was the 
least hope of beneficial effects, this article succeeded in checking 
the serous discharges from the howcls and terminating the vom- 
iting. His formula for its ordinary use is, Acet. Plumbi ai, Opi- 
um gr.i, made into 12 pills, of which he gives one every half 
hour, until the rice-water discharges from the stomach and bow- 
els begin to decrease. 

The ordinary effect of these pills is that of gradually checking 
the serous discharges from the stomach and bowels; the impor- 
tance of which will be duly appreciated, when it is recollected 
that it is the continuance of this discharge which conducts on 
the disease to its incurable state. Although this diarrhoea ises- 
sentially a stage of the disease itself, still in practice it should 
serve as premonitory of those horrible phenomena which, with- 
out its arrest, must soon supervene, and which constitute the 
h ttcr stage of the disease. Any remedy then which may be 
possessed of competent power for stopping those exhausting dis- 
charges which are characteristic of the early stage of the disease, 
is eminently worthy the prompt attention of the profession. 

When the vomiting and diarrhoea were suspended, Dr. Graves 
advised the gradual discontinuance of the pills. In this way, he 
gave large quantities in a day, with great benefit, and without 
bein^ followed by any injurious consequences. 

This arrest of progress in this stage of the disease, secures at 
once to the practitioner, that, of which he has been heretofore too 
often deprived, viz. an opportunity for the effectual administra- 
tion of mercurial or other medicines, according to the dictates 
of his judgment. 

We have seen in the Western Medical Journal, some account 
of the use of sugar of lead in cholera, by Dr. Price of Montgom- 
ery County, Ohio. Notwithstanding he succeeded to a consid- 
erable extent in confirming the observations of Dr. Graves, rela- 
tive to the efficiency of this medicine in the first stage of Cholera, 
still it is observable that this practice was, with him, not so de- 
cidedly successful as with Dr. Graves. All Dr. Price's account 
of the use of the Acetate of Lead, appears to be marked by th; t 
candor and honesty which at once display the honest man, tl e 
practitioner of great merit, and the narrator who has for hisso'e 
object, truth, and the interests of humanity. But we hope that 
neither Dr. Price, nor any of his readers will be discouraged 
thereby, in the use of an article, which, from its known medicin- 
al powers, we should suppose adapted to the purposes herein 
designed ; and that, with the excellent authority by which its use 
in this disease has been introduced to the profession: for we are 
bound to consider Dr. Graves of Dublin, at least, as one of the 
most substantial practitioners now in the exercise of the profes- 
sion. We will further remark, that we think the cause of the 
difference of result in the practice of these two gentlemen is very 



316 Acetas Plumbi in Cholera. [Oct. 

obvious; and is not calculated to impair the confidence which 
Dr. Graves' experience has created. 

In the first place, the opportunities afforded Dr. Price, as to 
the number of cases, have not been at all comparable with those 
of Dr. Graves. And, in the second place, we should look for a 
different result, from the different doses adopted by them — the 
dose used by Dr. G. being 3£grs. acct. plumb, with 1-12 gr. opium ; 
whilst that of Dr. P. was 10 grains of the former, with 1 grain 
of the latter. 

" That the secretion of bile will return, if that of scrum be ar- 
rested, is established by the above facts," says Dr. Price, after 
speaking of two cases in which the sugar of lead and opium had 
effectually constipated the bowels and checked the vomiting, and 
in which he had then produced bilious discharges by cathartic 
medicines, " In both of these cases," continues the Dr., "pur- 
gation was with great difficulty brought about, after the use of 
lead and opium ; and in one case, was only effected with Croton 
oil, after the use of a variety of cathartics to no effect." By 
these candid statements of Dr. Price, we have reason to believe 
that the increased dose which he used was out of proportion to 
the demand of the different latitude, climate and locality of Mont- 
gomery County in Ohio, (which borders on the 40 ° of N. L. 
and ranges with Philadelphia.) for the use of those articles: rind 
that consequently, the effects were too severe for the best inter- 
ests of the cases. 

Of the peculiarities of that locality we are not able to speak ; 
but latitude does (cet. par.) exert a material influence on cli- 
mate. This influence varies, however, by the different expo- 
sures of the tract of country ; as remarked on the different sides 
of the Alleghany Mountains.* Whilst on the subject of the in- 
fluence of climate, which always bears a close relationship to 
latitude, it may not be amiss to remark, that our observation 
leads us to the opinion that the susceptibility of the system for 
the action of different medicinal powers is not varied alike by this 
influence; but that whilst the susceptibility for some articles is 
materially decreased, or increased, that for others is not appre- 
ciably altered. 

Wc have remarked that the susceptibility for mercurial and 
antimonial powers decreases, with considerable regularity, with 
the decrease of latitude, and that the local peculiarities engen- 
dered by a southern clime still farther influence, more or less, 
this proportion between the varying susceptibilities of the sys- 
tem and the differing latitude! "For example, in the use 
of those articles in (.'corgi;,, we add about 100 pr. cent, to the 
dose necessary in New York and Massachusetts, which range 

*We arc aware oft lie fact, that the higher latitude? west of the AUeglia, 
ny, arc more temperate than the same on the cast. 



18,30.] Acelat Plumhi in Cholera, <$-r. 317 

about 42 ° N. L., a difference of about 10 ° . In Louisiana the 
increase of dose, for the same kind of operation, is still more: 
and the experience in that part ofHindoostan which lies between 
Bombay, and the Coromandel and Malabar coasts, and other 
parts of India ranging with it, extending mainly from the 10th to 
the 20th degree N. L. proves an increased demand of more than 
double the portions necessary for the same manner of effect in 
this latitude: Georgia and Louisiana being about a middle lati- 
tude between Boston in the north, and Bombay and Aracan in 
the south. At Madras, Seringapatam and Tanjore, the quanti- 
ty for the same still increases. The increase in these southern 
parts of India is still greater than the ordinary effects of the dif- 
ference of climate, or latitude alone, owing to the peculiarities in 
their localities, &c. 

It is not, we believe, a fact of observation, that narcotic and 
anodyne powers, lose their influence at, or near the same rate, 
on approaching the equator ; although they do vary in an ap- 
preciable degree. But styptic and astringent powers have not 
been found to vary in any perceptible degree, unless indeed, as 
there is some reason to believe, their power be increased. 

The southern practitioner is never found to excede 2^ to 5 gr. 
doses of ace t. plumbi, unless on some very extraordinary occasion 
indeed; whilst the dose at the north is generally 5 to 10 grains. 
Compound powder of alum, is generally found to display its full 
powers in the south, in doses of 8 to 12 grains, and larger doses 
are generally rejected by the stomach, whilst the northern dose is 
5 to 20 grains. 

More minute and extended observations on the change of sus- 
ceptibility for the action of different medicinal powers, would be 
of great interest to the profession, and would tend to heal the 
thousands of errors in prescription, which are daily made in one 
climate, from the books, instruction, or even the experience of 
another. 

If these views be correct, we should be inclined to believe, 
that even the precise dose of Dr. Graves, repeated pro re nata, 
would have been the most appropriate for the cases of cholera 
in the west. After each dose, as was the case in the hands of 
Dr. Graves, spontaneous bilious secretions might have been af- 
forded, or these might have been easily produced by mercurial 
purgatives, instead of needing Croton oil, after many other pur- 
gatives, to overcome constipation. 



When we presented to our readers Dr. Graves' remarks on 
the use of the Chloride of Soda in fevers, in the second number 
of this Journal, we intended to append a note, correcting an er- 
ror in nomenclature, which pervades the whole article as it ap- 
pears in the London Medico-Chirurgical Review, and which 
also occurs in the British and Foreign Medical Review. It is 



318 Alum in Typhoid Fevers, §c. [Oci. 

very evident that Dr. Graves has reference to the Chloride o{Soda, 
(that is, the Chloride of the Oxide of Sodium,) and not the Cltlo- 
ride of Sodium, which is common salt. We were more desir- 
ous that this error should have been corrected, because we had 
known a druggist in this city send common salt to a physician at 
a distance, who had inadvertently in writing an order for drugs, 
written for the chloride of sodium instead of soda ; but in the 
hurry of business it was neglected and forgotten until the pre- 
sent number. We beg leave to call the attention of our readers 
again to Dr. G's. valuable observations, and request them to 
read Chloride of Soda, in place of Chloride of Sodium. 

We have, since the publication of the article referred to, em- 
ployed the Chloride of Soda according to the directions and un- 
der the circumstances, as recommended by Dr. Graves, and in 
some cases have been very much gratified with its effects. 



Alum in Typhoid Fevers. — Professor Fouquier, one of the physicians of 
La Charite is in the habit of prescribing alum, with considerable success, in 
certain cases of typhoid fever. When the inflammatory symptoms which 
generally mark the commencement of fever are succeeded by the symptoms 
peculiar to typhus, such as weakness of the pulse, fixed and dull expression, 
diarrhoea, acrid heat of the skin, &c. alum is advantageous. If inflamma- 
tory symptoms should re-appear, its use is again counteracted ; so it is if the 
bowels (which rarely happens in the second stage,) are constipated ; but 
with these exceptions it may be confidently given, although the most seri- 
ous nervous symptoms are present. In the stage of collapse, when there 
is excessive prostration of strength, colliquative diarrhoea, sordes covering 
the mouth, and foetid excretions, alum, either alone or with other remedies, 
acts very beneficially. The diarrhoea diminishes, the tongue becomes moist, 
and the strength improves. The dose is twenty-four grains daily for three 
or four days, then increased to half a drachm, and after the same interval to 
a drachm. When its good effects have been produced, the dose is to be di- 
minished in the same proportion. Gum-water is a suitable vehicle : it may 
be given in pills, but a solution is preferable. — British and Foreign Review,— 
Bulletin general de Therapeutique, Novembre, 1835. 



On the proper Temperature of Sinapisms. — The volatile oil, on which the 
stimulating properties of the powdered seeds of mustard depend, is not dis- 
engaged or formed unless water is added to them ; but it has been imagined 
that very hot water was preferable to cold. M. G. Faure, senior, has 
proved, by many careful experiments, that this is not the case, but that wa- 
ter, when heated to 192° (F.) and upwards, prevents the disengagement of 
the volatile principle of mustard : consequently, that sinapisms should be 
made with cold water, and for foot-baths the powdered mustard should be 
first mixed with some cold water, to which boiling water should be added, 
to raise it. to the necessary temperature. By one of those coincidences 
which are not uncommon, the same facts have been simultaneously discov- 
ers! by MM. Geiger and Hesse in Germany. The most satisfactory ra- 
tionale is, thai the sudden heat coagulates the vegetable albumen which 
form to each molecule, that prevents the water acting upon it. — 

All causes which coagulate albumen produce the same effect, such as alco- 
hol, strong acid-, &c« Cold waler, on the contrary, dissolves the vegeta- 
ble albumen. — British and Foreign Review. — Journal de Pharmacie, Sep- 
tembrr, 1835. 



1830.] Hydrated Tritoxide of Iron an Antidote to A rsenic. 3 1 9 

Hydrated Tritoxide of Iron an Antidote to Arsenic. — This antidote is eas- 
ily prepared and should be always in readiness. An ounce of iron filings, 
with lour ounces of nitric acid and four ounces of muriatic acid, wore intro- 
duced into a large ghss vessel, and subjected to a gentle heat until the iron 
Was dissolved : to this solution sixteen ounces of cold distilled water were 
added, and after some minutes the metal was precipitated by introducing 
two or three ounces of liquid ammonia. The vessel was then filled with 
common water, agitated, and the whole filtered-. This left about twelve 
ounces of Hydrated Tritoxide of Iron. A teaspoonful weighed about an 
ounce. The process occupied about an hour, and it was immediately re- 
peated. 

A very strong case is given by M. Geofiroy in the Journal de Mt'decine et 
de Chirurgie pratiques, in which 3 i. of arsenic was deliberately taken by a 
hair-dresser, labouring under delirium tremens. After several glasses of 
sugared water, four or five pints of warm or cold water, charged with the 
Hydrated Tritoxide of Iron, were given in a quarter of an hour. Copious 
vomiting and a large stool were produced. For the next seven or eight 
hours this treatment was continued, and the patient vomited and was purged 
three times. There was neither colic, heat in the throat, nor any symptom 
of poisoning. He complained of cramps in the fingers ; but was delirious 
the whole time, talking and gesticulating. The quantity of the drink was 
diminished — he slept well, and in the morning was well. 

It should be observed, that after the arsenic was swallowed, and the 
friends ascertained it was arsenic, M. GeofFroy was sent for ; and after his 
arrival, which was very soon, twenty minutes were required to obtain the 
tritoxide. 

MM. Bineau and Majeste, of Saumur, relate the following cases, to prove 
the efticacy of the hydrated peroxide of iron as a counter-poison to arsenic 
in the human subject. On the 13th of August last, about two o'clock, five 
little girls, on leaving school, ate part of a cake, containing one-fifth of its 
weight of white arsenic, which had been prepared to kill rats. 

L. D., a3t. 7, who had eaten a piece weighing about two drachms, had, 
half an hour afterwards, pain in the throat, a sensation of strangulation and 
vomiting, succeeded by pains in the belly, great thirst, faintness, incessant 
restlessness, and spasms. Dr. Bineau saw her at four o'clock : she had then 
vomited five times, and rejected sugared water and milk which she had 
swallowed. He gave her one grain of tartar emetic, which produced vomi- 
ting and two stools. In an hour he had prepared the tritoxide of iron, and 
by nine o'clock he had given five ounces, in divided doses. During this pe- 
riod she vomited five times, and had one black foetid stool : there were stu- 
por and slight convulsions of the limbs. At ten o'clock these symptoms 
were relieved ; she slept quietly, and was well the next day. 

M. G., act. 5i, swallowed about three drachms of the cake, and a quarter 
of an hour afterwards vomited. Between this time and five o'clock she 
vomited twenty times, and rejected all fluids. After vomiting, faintness and 
depression, followed by extreme restlessness, pain over the whole body, 
(particularly in the belly and legs,) cold perspirations, livid face, great thirst. 
At four o'clock there was great and constant stupor, without loss of intelli- 
gence. At five o'clock, M. Bineau administered five or six drachms of the 
hydrated tritoxide of iron, and repeated the dose frequently at first, and 
gradually increasing the intervals until ten o'clock. During this time she 
vomited only three times, and the pain ceased ; but there were constant and 
alarming stupor and depression. At ten o'clock the pulse rose, and at four 
she slept naturally. In the morning she had two stools. No subsequent 
symptom. 

The other three cases were treated by M. Majeste. 

Marie B., aet. 7, and Louise, her sister, set. 5, each ate about two drachms 
of the cake. At four o'clock M. Majeste saw them : the face of the eldest 



3&0 Fumigations in Hooping-Cough, <§>c. [Oct. 

was contracted, pale or livid, eyelids injected, great thirst, very hot skin, 
pulse T-iO, belly tympanitic and painful, particularly the epigastrium, gener- 
al depression, and constant vomiting and purging, since the poison had been 
taken. The symptoms of the younger were rather milder. M. Majeste 
returned to his dispensary, and in less than an hour prepared twelve ounces 
of the hydrated tritoxide of iron, and he gave to each two ounces at four 
doses, in twenty minutes. The vomiting ceased, but returned in an hour, 
when he gave two ounces more at longer intervals, and a lavement with 
half an ounce. At eight o'clock the vomiting returned with colic, and an 
ounce was given to each, with half an ounce in a lavement: the vomiting 
ceased, and did not return. They passed a good night. W ith the excep- 
tion of some little intestinal irritation, and an~eruption in the eldest, which 
yielded to simple treatment, there were no other symptoms. 

The other child, aged 9, was less violently affected. The vomiting ceased 
on taking the antidote, and in eight hours after the attack all danger was 
over. 

The action of the tritoxide as an antidote was evident. The dose in each 
case was very large, above thirty grains of arsenic ; and, although vomiting 
took place, yet a much smaller quantity has been often known to kill, al- 
though there was vomiting. The symptoms were always immediately re- 
lieved by the iron. The antidote itself appears harmless, as from four to six 
ounces were given to each child without any ill effects; and, as this is the 
case, it is advisable, even long after the poison has been taken, to estimate 
the quantity rather by its effect on the symptoms, than by any proportion to 
the poison, It is advantageous that this antidote is tasteless. — British and 
Foreign Review. — Journal des Connaissanccs Medico- Chirurgicalcs, Novem- 
bre, 1835. 



Fumigations in Hooping- Cough. — Dr. Dohm, of Heide, in the duchy of 
Holstcin, has accidentally discovered a remedy for hooping-cough, that pro- 
mises to be of considerable use in that too-oftcn obstinate and dangerous 
disease. Two of his own children, a boy and a girl, (the former one, and 
the latter three years old,) had been suffering from hooping-cough for be- 
tween two and three months ; during which time several remedies, inclu- 
ding belladonna, had been tried m vain. The paroxysms were very frequent 
ami extremely violent, so that the faeces and urine used sometimes to be ex- 
pelled involuntarily. An accident of this kind occurred one evening during 
the absence of the father ; and, to remove the ill smell thereby occasioned, 
the bedroom was fumigated, and that to such an extent that the child was 
enveloped in the smoke. Contrary to the expectation of the doctor, the 
child had not another attack that night; the cough became much milder, 
and the repetition of the same treatment soon cured it. This encouraged 
him to try it in other cases, and he invariably found the paroxysm greatly 
relieved by it, if not completely stopped. The fumigation was made with 
the common species of fumales of the Pharmacop. Slesvico-llolst. (Olibani 
hbr. dins, BenzoeB, Styr, Calamitffi, sing. libr. dimid., Flor. Lavendul., Ro- 
sar. rub., singul. unc. qoatuor.) lie [we think, very justly,] considers the 
benzoin to be the most efficient ingredient. — British and Fori ign Review. — 
Pfqff's MUiheilungen. 



ERRATA. 

Page 208, line 11, for fistula in and, read fistula in a\o. 
Same page, second paragraph, last line, fur bonc-likc, read 

BOW-LIKE 



SOUTHERN MEDICAL 

AND 

SURGICAL JOURNAL 

Vol. L] NOVEMBER, 183G. [No. 6. 

Part I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Medical reflections, with two cases of Spinal Irritation, Simula- 
ting Colic and Gastro-Enteritis. By J. W. Heustis, M. D. 
of Mobile. 

The enterprising and indefatigable researches of the physiol- 
ogists and pathologists of the present day, and we may say of 
the medical profession generally, have greatly extended the scope 
of observation and inquiry, and produced more enlightened views 
m relation to the functions, diseases, and influences of the ner- 
vous system in all its phenomena, bearings and relations, as well 
in health as disease, than were ever anticipated in the days of 
Cullen and Brown. This is as it should be. No physician, 
who properly estimates the exalted dignity and responsibility of 
his profession, can consider any labor and assiduity too devoted, 
that have for their object the alleviation of the amount of human 
suffering, of mitigating the pangs of disease, and of contributing 
to the restoration and health of the afflicted. An office so be- 
nevolent and god-like, when undertaken with the true spirit. 
confers a dignity upon human nature, and gives a character of 
respect and veneration to the enlightened and successful prac- 
titioner, alike calling forth the admiration and esteem of the civ- 
ilized and barbarian. And what feelings can be more congenial 
to the heart than those produced by the overflowings of grati- 

11 



Medical Reflections, tyc. [Nov. 

tude, greeting the physician wherever he goes, as the messen- 
ger of comfort and the disposer of blessings — to possess such a 
hold upon the confidence of the sufferer, relatives and friends, 
that the very appearance of the familiar and cherished counte- 
nance of the physician, lights up the beams of hope upon the vi- 
sage of anxiety, suffering and despair? True, we sometimes 
meet with unmerited and ungenerous treatment and mortifica- 
tions, from the fickleness and caprice of those who should have 
considered themselves under permanent obligations. Cases of 
this kind, however, are so common, that they should cease to leave 
any permanent impression on the mind of the more experienced, 
satisfied in himself in relation to the correctness and propriety of 
his conduct. The payment of an account is generally consid- 
ered the liquidation of all obligations : with respect to the medi- 
cal profession, however, such an idea is illiberal and unjust. It 
is rare with us that the fees are larger than are necessary to 
cover the expenses ; so that without other resources, the physi- 
cian must be content to drudge on through years of penury, well 
satisfied, if in the decline of life he is placed beyond the reach of 
want and apprehension. And is such a perquisite a full equiv- 
alent for all assiduity, solicitude and care? Is it thus that our 
services are considered in the light of mere mechanical or mer- 
cantile employments ? To a sentiment so unworthy, it has been 
my good fortune to know many and honorable exceptions — ex- 
ceptions, affording a satisfaction more pure and genuine, than 
any that could be yielded by mere pecuniary reward and com- 
pensation. With these remarks, I enter upon the more imme- 
diate subject of consideration. 

The connexion of rheumatism and various painful affections, 
with existing irritation in the spinal origin of the nerves of sensa- 
tion and volition, has shed a new light upon the former disease, 
promising to be of essential practical utility, as well in this as in 
other affections which it may resemble in character and symp- 
toms. As serving to elucidate this subject, I submit the two fol- 
lowing cases, much abridged and condensed. 

Case 1. I was called, Sunday, July 10, to see Mrs. W. — 
During my absence, Dr. B. had been called in, and had bled her. 
As I, however, was the attending physician in the family, the 
case came more exclusively under my care. The attack had 
very much the appearance of a violent colic, viz. excruciating 



1830.] Medical Reflections, fyc. 323 

pain in the bowels or abdomen, and a strong spasmodic undula- 
ting heaving of the thorax and abdomen at every inspiration, by 
which the latter was thrown convulsively and violently forwards. 
These symptoms were relieved by bleeding and the subsequent 
free use of laudanum and other antispasmodics. There were 
still, however, great soreness and tenderness of the abdomen on 
pressure, for which the lancet was used twice, besides the free 
bleeding at the commencement of the disease ; the warm bath 
was also used, and also warm fomentations. On the third day 
of the disease, to open the bowels, a moderate dose of caster-oil 
was exhibited ; as this operated too freely, an opium pill was gi- 
ven. From this time she was seized with convulsions, which 
would frequently recur at irregular intervals, perhaps as often 
as eight or ten times in the course of the day. At night she w r as 
generally composed, and rested well with the aid of an anodyne, 
given either by the mouth or injection. She also took infusion 
of valerian, as there was little or no excitement. Pills composed 
of the blue mass , calomel and camphor, were also exhibited. — 
As she complained much of her head, this was repeatedly cupped 
and blistered, as was also the region of the stomach. As there 
was tenderness about the lower portion of the dorsal vertebrae, 
a cup was applied to this portion of the spine, and subsequently, 
a blister. 

July 16. The blister drew well, but notwithstanding this, and 
the various other means, she has had several severe convulsions, 
and now lies in a state of stupor. 

July 17. Had the cuticle removed from the blistered part, 
and the surface dressed with cerate, containing about one grain 
of the acetate of morphia : took an anodyne injection last even- 
ing, and has been taking to-day, every two hours, about the sixth 
of a grain of the acetate of morphia, and two grains of the blue 
pill : took also, this evening, an anodyne enema, as there were 
symptoms indicating the return of spasms. The opiates have 
produced nausea and some vomiting; let them be discontinued: 
has had no return of spasms since the evening of the 16th. 

The pains, spasms and convulsions now, became much miti- 
gated, and their return protracted to longer intervals. Great 
relief appeared to be afforded by dressing the blistered surface, 
with simple cerate, containing about half a grain or more o( the 
acetate of morphia to each dressing. As there were pretty dis- 



324 Medical Reflections, <$•€. [_N ov. 

tinct intimations given of the threatened attack of convulsions, 
by the appearance and sensations of the patient, these were pre- 
vented by enemata of starch, containing two or three drachms 
of laudanum. Under this treatment she soon recovered. 

The first decided impression was made by the blisters and the 
application of morphine to the denuded surface. The anodyne 
injections were also of essential benefit. It is worthy of remark, 
that the cupping of the temples, and all the applications that 
were made to the head were entirely unavailing, clearly showing 
that this was only sympathetically affected. 

From all the circumstances connected with this case, I was 
convinced that its seat was in the spinal origin of the nerves of 
the lumbar vertebrae, or in the cord itself; and with this view the 
treatment was finally directed. And it is proper to mention, 
that previously to each attack of convulsions, she would be 
seized with intense pain in the spine, sympathetically affecting 
the head at the same time. 

Case 2. Mrs. D. had been confined to her bed a number of 
days, with what was called a bilious colic, and for which she had 
been treated accordingly, by her attending physician. As hey 
case continued without improvement, and the symptoms became 
alarming, it was deemed expedient to hold a consultation. She 
complained of severe abdominal pains, subject to frequent exa- 
cerbations, for which her only relief was in the free use of mor- 
phia. As there were some symptoms resembling those of the 
case above related, I suspected an affection of the lumbar or 
dorsal nerves, or of the cord from which they originate. Upon 
pressing upon the spinous processes along the four or five lowey 
dorsal vertebra), and the upper portion of the lumbar, she shrunk 
from the touch, making great complaint of the tenderness and 
pain therefrom : and, indeed, she referred the origin of her ab- 
dominal pains to the spine, radiating from thence as a common 
centre. 1 suggested to her physician, the propriety of exciting 
counter-irritation of the spine, by blisters or tartar emetic. He, 
however, appeared rather to lake a different view of the case, 
considering it as chronic enteritis, originating from an attack of 
bilious colic; and so we compromised, directing the warm bath 
occasionally, morphia to allay the pain, enemata to keep the 
bowels free, and food of the mildest and least irritating kind, as ar- 
row root, crackers and tea.drv toastand things of that description. 



183G.] Hfedical Reflections. $c. 325 

She was already in a state of salivation, and the cheeks and 
fauces were considerably ulcerated. In nearly the same situa- 
tion she remained several days, under similar treatment, occa- 
sionally a little better and then worse, without any permanent 
improvement. The pulse was rather full and strong for a person 
in her debilitated state, although she had been bled the day pre- 
vious. As the case belonged more exclusively to the former 
physician who had previously attended her, I saw her but seldom. 
On the 18th of August, I was particularly requested to visit her 
again; there was but little alteration; she was still confined to 
her bed. She complained of great tenderness and soreness of 
the abdomen, along the tract of the colon, for which I cupped 
her, but without any permanent relief, as she was attacked the 
next day with pain and spasm as violent as ever. Agreeably 
to my original idea, I now applied a pitch-plaster, strongly im- 
pregnated with tartar emetic, to the affected portion of the spine. 
She still found it necessary to use the morphine. Her former 
physician saw her, in company with me, and from his represen- 
tation of the previous good effects of mercury and salivation in 
her case, she was put upon the use of the blue-pill night and morn- 
ing. On the 23rd of August, four days from the application of 
the plaster, I found her sitting up for the first time, attending to 
some light domestic employments, quite cheerful, saying that she 
was getting well — that she could now put her feet to the floor 
without that dreadful pricking and stinging sensation that she 
before experienced in her feet when attempting that movement. 
Upon enquiring whether the plaster had produced any uneasi- 
ness of the back, she said it had, and that it was very sore and 
raw, but that she did not regard that if it would only assist her 
recovery. Her former physician had, a day or two previously, 
suggested the propriety of putting her upon the use of the blue- 
pill, with ipecac and opium, every two hours. She wished to 
know of me whether the object was to produce salivation, I re- 
plied that was, in part, the design ; she thereupon strongly pro- 
tested against the prescription, and against the use of mercury in 
any quantity or form, having already, as she said, suffered so 
much from salivation. The prescription was not insisted on, and 
her rapid convalescence rendered it unnecessary. 

I consider the tartar emetic plaster, as the sole efficient agent 
in the relief of this case. 



326 An Account of Cholera, fyc. [Nov. 

The probability is, that were cases of supposed colic and en- 
teritis more closely analyzed, they would frequently be found to 
proceed from spinal irritation ; and, indeed, so important is the 
relation which the medulla spinalis bears to the general system, 
that in all painful, spasmodic and convulsive affections, its exami- 
nation should never be neglected. 

Mobile, August 31, 1836. 



ARTICLE II. 

An account of Cholera, as it prevailed in the City of Savannah 
and its vicinity, in the Fall of 1834. By P. M. Kollock, M. 
D., of Savannah, Georgia. 

Since the subject of Cholera began, more particularly, to at- 
tract the attention of European and American physicians, its 
history, pathology, treatment, and in fine, every circumstance 
relating to the disease, as presented to the observation of those 
who have witnessed it, have been so minutely and voluminously 
discussed, that it might appear rather supererogatory and per- 
haps presumptuous, to attempt at this time to present any thing 
which could be considered original, or at all interesting in regard 
to it. But, however minute have been the descriptions, and how- 
ever voluminous the essays on the subject, every man of judg- 
ment and candour, every one interested in the establishment of 
truth, and in the advancement of science, is compelled to ask 
himself the question — How much good have they done ? how 
much have they contributed towards the establishment of the 
pathology of the disease, and more particularly of its treatment? 

In considering the first part of this query, the philanthropic 
physician has much cause of triumph and rejoicing. The scal- 
pel of the pathological anatomist, particularly of our own coun- 
try, has revealed to us most satisfactorily, the condition of the 



1836.] An Account of Cholera, fyc. 327 

organs, which is the result of the operation of this most mysteri- 
ous agent — and taught us that cholera is not to be considered a 
disease of extreme debility, in any of its stages, and demanding 
for its cure the administration of the most powerful stimulants 
known to us ; but rather that it is to be classed with those disea- 
ses which exhibit the phenomena of the most intense phlogosis. 

Far less reason, however, has the profession to exult in their 
success, in having established a sure and uniform course of treat- 
ment, deduced from a pathology, which seems so clearly and sat- 
isfactorily ascertained. Notwithstanding the apparent certain- 
ty which exists in regard to this point, the treatment of the dis- 
ease in general is as fluctuating and unscientific as can well be 
conceived; and consequently its success is proportional. On 
this account, when it makes its appearance, practitioners, as well 
as patients, are panic-stricken — their unsettled notions lead to 
failure in practice — the community lose confidence, and are rea- 
dy and anxious to plunge into the vast ocean of empiricism. 

Having had cause to feel most forcibly the truth of the above 
remarks, I have been induced to offer the following paper to the 
notice of the profession in this section of country, not with the 
hope of presenting, in any strikingly original point of view, a 
subject, about which so much has already been written, or of 
adding any thing very important to the mass of information on 
the subject. But believing that the disease on its irruption at this 
place, exhibited features differing in some respects from what 
were observed in other parts of the country, particularly at the 
North ; and consequently that it required a modification of treat- 
ment accordingly, my object has been to invite the attention of 
Southern physicians to these points, in order that they may test 
the correctness of my observations, and with the hope that my 
hints may not be found altogether without utility. 

This fell destroyer of human life had visited almost every 
part of the American continent, before it reached Savannah.* — 
Early in the Summer of 1834, it broke out in Canada and New 
York, and we could not hear of its being nearer Savannah than 
Washington City, when about the 1st of September, it was re- 
ported by the health-officer of the port of Savannah, that some 

*It had approached in October, 1832, within 100 miles of Savannah — ha- 
ving been carried to Folly Island near Charleston, in the brig Amelia, from 
New York, which was wrecked on Folly Island. 



328 An Account of Cholera, fyc. [Nov. 

cases very much resembling in their appearances, Cholera As- 
phyxia, had occurred on the plantation of Maj. Wightman, about 
12 miles above the city, immediately on the Savannah River. 
These cases were soon followed by others. The disease con- 
fined itself to this plantation for, some little time, and the number 
of cases was large, before it extended itself to other adjacent 
plantations. It at length progressed, and after attacking one or 
two places above Maj. Wightman's, pursued a downward course, 
until it visited every plantation on the river, even the last below 
the city. This occupied about three weeks, and during this in- 
terval there occurred but six or eight deaths in the city, and 
most of these cases originated in the country. 

A very few days after the disease broke out at Maj. Wight- 
man's, we heard that it had made its appearance on the River 
Ogeechee, 15 miles from Savannah, and without any of the in- 
termediate places being affected. 

Cases of the disease continued to occur in the city and along 
the course of the Savannah river, until late in the Fall. Since 
1834, cases have occasionally been met with, resembling the 
disease under consideration, more or less nearly ; but usually 
they have proved very manageable. 

In the year 1832, when Cholera first made its appearance in 
America, and prevailed to such an extent in our northern and 
western cities, there was observed a very strong predisposition 
to bowel affections among the inhabitants of this vicinity, in com- 
mon with those of all other parts of the United States. So much 
was this the case, that we were obliged to administer cathartics 
with the greatest possible caution, in the treatment of our ordin- 
ary fevers. But in 1834, previous to the appearance of the dis- 
ease at Maj. Wightman's, it is remarkable that there was no 
strong epidemic tendency to bowel affections observed. As the 
disease advanced, the predisposition accompanied it, and three- 
fourths of our population were affected with cholerine or chole- 
raid. It was remarked, however, by other physicians, as well 
as by myself, that other diseases did not so far assume the "liv- 
ery" of the reigning epidemic, as to render any material modifi- 
cation of their treatment necessary. In the treatment of our or- 
dinary fevers, we were enabled to prescribe cathartics with the 
same freedom as in ordinary seasons. 

According to the accounts of writers on the subject, it will be 



1830.] An Account of Cholera, fyc. 329 

observed that Cholera, among us, differed in this respect from 
the disease which prevailed elsewhere. The symptoms of the 
disease which raged in this vicinity, were at variance in many 
respects with what it assumed in other places. According to 
my observation, the cramps in the extremities were not as much 
complained of as is generally stated — nor do I think that the 
discharges from the stomach, bowels, and skin, were usually as 
profuse. It was not always possible to ascertain with precision, 
the quantity which had been discharged from the stomach and 
bowels; but I judged of the lesser profuseness of these discharges, 
by what I could gather from enquiry, and from the extremely 
phlogosed condition of the mucous membranes, which remained 
after death, as discovered by dissection. When the dischar- 
ges have been very profuse, the inflammation is relieved, and 
there are no traces of it observed in these membranes, excepting 
such as are indicated by their diminished consistence, &c. In 
every case it could be ascertained on enquiry, that the patient 
had been affected with diarrhoea, accompanied with more or less 
pain in the bowels, for some days or hours previous to the su- 
pervention of collapse; and this diarrhoea was always at first 
bilious. With greater or less rapidity, the stools lost their bil- 
ious appearance, became almost perfectly transparent, or semi- 
opaque, like water in which rice has been washed or boiled — and 
often the same matter was thrown up from the stomach. The 
patient soon became as cold as marble ; lost his pulse ; the skin 
for the most part was dry, and not always shrivelled ; but inelastic. 
The tongue w T as sometimes blue and cold — at other times warm, 
always moist — sometimes clear, then again foul: The patient 
in the cold stage complained of no pain, merely of weakness and 
fatigue. Sometimes when not disturbed, he lay in a stupor, with 
his eyelids half closed, and the balls turned up ; at other times 
there were great restlessness and tossing from side to side. The 
voice in some cases was very weak, and reduced to a whisper ; 
in others, where the collapse was confirmed, the voice continued 
nearly as strong as natural. Although great weakness was com- 
plained of, the muscular strength was retained to a surprising 
degree. I have been informed by other physicians, that they 
observed the sensibility impaired to so great a degree, that boil- 
ing water poured on the skin was scarcely felt. I did not notice 
this in any case. I poured boiling water on the legs of a negro 

42 



330 An Account of Cholera, $c. [Nov. 

man in confirmed collapse, which he felt so acutely, that he leaped 
up instantly and appeared to be in great agony. 

In those cases which were fortunate enough to pass through 
the stage of collapse and react, a pretty severe bilious fever suc- 
ceeded, attended in some instances with violent gastritis, as 
manifested by the blood-red and furred tongue, and with great 
determination to the brain, producing coma more or less intense. 
Sometimes this reaction rose so high, as to require very profuse 
and frequently repeated bloodletting, to protect important organs. 

My personal acquaintance with Cholera, commenced at the 
plantations of the estate of Thomas Young. On the 6th of Sep- 
tember, 1834, 1 visited the place on the upper part of Hutch inson's 
Island, called " Ham." Two negro men had been attacked with 
the disease, while cutting rice in the field, and were found dead 
on my arrival. It is most probable that these individuals had 
laboured under diarrhoea some days or hours previously, which 
had been neglected by them — the fact, however, could not be 
ascertained. 

On the 7th of September, I visited the back river plantation* 
called u Fife." I found two men collapsed — one with very little 
pulse, the other with none. Not having seen any case previous- 
ly, I prescribed the treatment which I understood had been suc- 
cessful at Wightman's, and which was as follows: R. Calo- 
mel, gr. x. ; Gum. Camphor, gr v.; Gum. Opii. gr. i. : every 
hour. — Sinapisms to the extremities and abdomen. I endeav- 
ored to excite vesication by pouring boiling water on the ex- 
tremities ; but found it productive of such extreme distress, even 
in the deepest collapse, and attended with no perceptible good 
result, that I very willingly abandoned it. 

Uncertain as to the treatment best adapted to the disease, as 
presented to my notice, 1 determined to avail myself of the first 
opportunity of post mortem examination, in order to ascertain, 
if possible, the true pathological condition of the organs. Ac- 
cordingly two cases presented themselves — both had passed into 
the stage of collapse before I saw them. The treatment above 
detailed was prescribed — death supervened in from 12 to 24 
hours after they took to their beds, although I have no doubt a 
diarrhoea must have existed previously. At the time of their 
death, they had taken about xl. grs. Calomel, xx. gr. Camphor, 
iv. gr. Opium, 



1830.] An Account of Cholera, fyc. 331 

In the first case examined, the mucous coat of the stomach was 
found intensely inflamed throughout — the Calomel had not pass- 
ed from the stomach. There was a slight inflammatory blush 
throughout the mucous coat of the small intestines, which con- 
tained a tenacious creamy matter. The large intestines exhib- 
ited no traces of inflammation, they were entirely empty, with 
the exception of the Coecum, which contained small particles of 
hardened feces resembling gall stones. The vessels of the ex- 
ternal coat of the intestines were much injected, and the whole 
exhibited a bluish tint. The liver was pale and exsanguine ; 
gall bladder distended with bile; kidneys pale and bloodless; 
spleen rotten ; bladder contracted and empty ; mesenteric glands 
enlarged. The abdominal muscles, when cut through, exhibi- 
ted an unusual stagnation -of blood in the small vessels. 

The second case examined displayed the same intensity of 
gastric inflammation as the first; but in this case, the inflamma- 
tion of the intestines was quite equal to that of the stomach, and 
in the colon blood was effused in several spots. The intestines 
and stomach were filled with the rice water effusions In this 
case, the bladder contained some urine. The appearance of the 
liver, kidneys, mesenteric glands, and external coat of the bow- 
els, was similar to what was observed in the other case. In both 
cases, the fat of the omentum, as also that surrounding the kid- 
neys, was entirely absorbed. In the last case, the spleen was 
natural as to size and consistence. 

As the result of this examination, I became averse to the em- 
ployment of active stimulants and narcotics, in the treatment of 
a disease which presented so many and such decided appearan- 
ces of intense phlogosis. The idea of applying camphor, opi- 
um, capsicum and alcohol, to such surfaces as the scalpel had 
brought to lijjht, was revolting in the extreme. I therefore en- 
deavored to adopt a practice as strictly sedative as possible. 

Bloodletting was accordingly resorted to at the commence- 
ment of the attack, when the subject was robust and the pulse 
active — a blister was applied to the abdomen — and gum-water 
the only nourishment allowed. 

In some slight cases, unattended with vomiting, a few grains 
of pulv. dover. were prescribed with benefit; soda-water was 
given to check vomiting; sinapisms and stimulating frictions, 
with an infusion of capsicum iu alcohol, or spiritus terebinth. 



332 An Account of Cholera, $c. [Nov. 

were employed to favor determination to the surface, where a 
centripetal tendency was observed. 

These means, in a vast number of instances, were sufficient to 
check the disease, even in some cases where collapse had com- 
menced. 

As the disease advanced in its career. I was induced to modi- 
fy the treatment and adopt a course still more antiphlogistic and 
depletory. 

Hitherto, I had refrained from the use of cathartics at every 
stage of the disease, and every thing calculated to increase the 
peristaltic action of the bowels — being governed by the injunc- 
tion of northern physicians, who asserted that instances were 
frequent, where the disease was aggravated, and the patient pre- 
cipitated into the stage of collapse, by the injudicious adminis- 
tration of a cathartic. And accordingly my efforts were always 
directed to arresting the frequency of the discharges, and for 
this purpose, as has been stated, the narcotics were occasionally 
employed. I found, however, that the first stage of the disease 
could be treated with more certainty, and much better effect, by 
the speedy removal of bilious accumulations, which usually ex- 
isted J?t that time, and by a total abstinence from narcotics. 

The following course was therefore pursued : The patient 
being attacked with cramps in the bowels and diarrhoea, with 
frequent and profuse bilious dejections, he was bled from the 
arm until the commencement of syncope, or until the pulse be- 
gan to yield — a large blister was applied to the abdomen — and 
as soon as the effects of the bleeding had subsided in some mea- 
sure, xx gr. of calomel were administered and succeeded by a 
table-spoonful of castor oil, in two hours ; gum-water the only 
drink allowed. 

When vomiting has supervened, and the discharges have as- 
sumed the rice-water consistence and hue, the cathartic is a 
doubtful remedy, and I think, should be avoided. The vomi 
ting will usually soon cease, if the patient is not allowed to take 
any thing into his stomach, even the smallest quantity of drink, 
and a sinapism applied to the epigastrium. When the collapse 
has commenced, venesection should be practised with great cau- 
tion, as I have seen it obliterate the pulse entirely, and confirm 
the collapse. 

The cold stage of the disease, -or as it is usually called, the 



183G.] An Account of Cholera, tyc. 333 

stage of collapse, was regarded here as elsewhere, the moribund 
condition. The patient has parted with an important portion of 
his vitality ; the hand of death is upon him. The vital spark is 
nearly extinguished, and we know not'with certainty, " where is 
that promethean heat, which can again its light relume." 

If the profession here cannot boast of more success in the 
treatment of this stage, than occurred elsewhere, I do not believe 
that they have to reproach themselves with less. Recoveries 
from collapse arc pretty nearly as rare, as from the black vomit 
stage of yellow fever; the community, therefore, should be 
deeply impressed with the importance of commencing the treat- 
ment of the disease with energy in its forming stage. Many 
lives have been lost by neglecting a midnight attack, until morn- 
ing light exhibited the hopelessness of their condition. 

The stage of collapse has generally been described, as induced 
by exhaustion from the immense effusions of the serous portions 
of the blood. Doubtless this explanation will suffice in many 
instances, and in such, the mucous coat of the stomach and in- 
testines is found free from all traces of inflammation, it having 
been reduced by the excessive effusion. But in a great number 
of cases which came under my notice, it did not strike me that 
this cxplanat : on was altogether satisfactory. It did not appear 
that the discharges had been as profuse, as were usually repre- 
sented ; and in most instances, the skin was dry, instead of being 
bathed in perspiration, and not shrivelled. This was the fact in 
regard to the two cases, the post-mortem examination of which 
has been detailed — and it was to the comparatively small amount 
of effusion, that was to be attributed the intensity of the mucous 
inflammation exhibited by them. It seemed as if the general ex- 
citement of the system, was wholly absorbed by that of the in- 
ternal organs, which induced the collapse. 

It would be difficult to say what course of treatment was not 
essayed by our physicians, during the stage of collapse. One 
plan was very nearly as successful as another. Some pushed 
the diffusible stimulant practice to the utmost extent ; others ex- 
hibited an incredible amount of mercury in an equally incredible 
short space of time. According to my observation, the patients 
under both plans, sank with more rapidity, than when they were 
left almost entirely to nature. Nor could it have been reasona- 
bly expected to be otherwise, considering the pathology of the 



331 An Account of Cholera, $c. [Nov. 

disease. For is it not more probable, that when the balance of 
excitement is so much in favor of the central organs, the appli- 
cation of active stimulants and irritants to them, will serve to fix 
this hyper-excitement more firmly ; and that it. will be much more 
difficult, if not impossible, to diffuse the excitement, however 
much we may stimulate the surface and extremities? 

Very soon after the appearance of Cholera among us, I tried 
during the cold stage the emetic practice, as recommended by 
Drs. Chapman and Hopkinson of Philadelphia. 

I visited a plantation below the city, where I found two ne- 
groes collapsed ; one a young girl, the other a middle-aged man. 
The girl was pulseless — the man not entirely so. The salt wa- 
ter emetic was administered to each, which vomited them ac- 
tively. The puking having ceased, xx. grs. of calomel were 
given, and it was directed that it should be repeated in x. gr. 
doses, every hour, until they had taken 3i. At my next visit, 
on the following morning, I found that the girl's system had react- 
ed completely — the man was in articulo-mortis, and died in a few 
minutes. The girl labored under the usual fever of reaction for 
some days, and slowly recovered. This was the only instance 
in which I observed this practice successful, although I em- 
ployed it repeatedly. 

I have siace, however, had reason to believe that the emetic 
would be followed by good results in many instances, if it is not 
succeeded by the calomel — and would therefore recommend, that 
when it be employed, every thing calculated to irritate the sto- 
mach and bowels in the smallest degree, should be withheld, 
and that the patient be allowed to take nothing but mucilagin- 
ous drinks in small quantities, of which gum-water is best. At 
the same time, the excitement should be invited to the surface, 
by the application of sinapisms and stimulating frictions. 

The emetic appears to act beneficially in some instances, by 
means of the shock which its operation communicates to the sys- 
tem, and the centrifugal impulse which it occasions. It is pro- 
bable that the emetic is better adapted to those cases, where the 
inflammation of the mucous membranes has been in a great mea- 
sure reduced, by the excessive profuseness of the; discharges. — 
Where there is much inflammation remaining, its utility is ques- 
tionable. 

I do not think that calomel should ever be given except in the 



I83t>.] On Intermittent and Remittent Fevers, c)-t\ 3J35 

forming: stae;e of the disease, and then as a cathartic. I consider 
it a doubtful remedy after the discharges have assumed the rice- 
water character. 

I am aware that the remarks, contained in this paper, may net 
escape the cavils of a portion of the profession. I give them, 
however, as the result of my convictions, and they must stand 
or fall by the test of subsequent experience. 



ARTICLE III. 

Remarks on the Pathology and Treatment of Intermittent and 
Remittent Fevers, with cases. By Lewis D. Ford, M. D., 

Professor of Chemistry in the Medical College of Georgia. 

I have united these two forms of fever in the following remarks, 
because of the striking resemblance of their features generally, 
and under the conviction of the great similarity, if not identity 
of their pathology. They resemble each other strikingly in the 
symptoms precursory of the formal attack, and in the first dis- 
tinct paroxysm so closely, that the most expert ob>erver will not 
pretend to foretell which of the forms the disease will subse- 
quently assume; also in the progression of the symptoms of a 
paroxysm and in its duration. We infer their general similar 
nature further, from the fact of their simultaneous appearance 
in different individuals under similar circumstances of exposure, 
and from the fact that they mutually run into each other. 

Taking it for granted, that they both arise from an external 
cause, which cannot be doubted, whatever difference of opinion 
may exist as to what that cause is, what it should be called, 
&c, the question naturally occurs — Can we render an account 
of the fact, that under the agency of this identical cause, one 



336 On Intermittent and Remittent Fevers, §c. [Nov. 

form is determined in one individual and the other in another? 
for if we can, we may be confirmed in the opinion of their gen- 
eral similarity and deduce from this explanation some useful 
practical directions. On exposure to this external cause, an in- 
dividual suffers a regular paroxysm of fever. After a certain 
intermission, comes another and another ; we may infer, that the 
cause, at the moment of becoming efficient in producing each 
paroxysm, finds the organs of the system generally in the same 
state, as at the commencement of the first — or if previous par- 
oxysms had produced alterations in some of them, they are not 
such as to counteract the regular succession of the phenomena of 
the paroxysm. But, while under the same external circumstan- 
ces, this case becomes remittent, when we will generally be able 
to discover some physical or functional signs of disorder of some 
of the organs of the head, chest, or abdomen — this morbid change, 
at first slight, not of a degree to produce danger, under a 
state of quietness approaching to that of health, but liable to be 
increased to a dangerous degree by the agitations of succeeding 
paroxysms; and it is matter of observation, that if these super- 
added disorders of the organs be not relieved, they are increased 
by every succeeding paroxysm, and disturb more and more the 
regular periodicity of the fever ; which in its progress to a fatal 
termination, exhibits more and more distinctly, the marks of this 
local affection. Hence we conclude, that if of two individuals 
under similar exposure, an intermittent be determined in one, 
and a remittent in the other, that there is some visceral irritation 
in the last, either pre-existing the attack and increased by it, or al- 
together determined by the first paroxysm itself, and that as long 
as the fever preserves its periodical character, even in this mod- 
ified degree, it does so under the influence of the same organic 
condition on which the perfect and regular periodicity of an in- 
termittent depends. 

What then is the pathology of this intermittent fever ? which 
from the time of the earliest records of medicine, to the physi- 
cians of all ages, has presented in its different forms, one unva- 
rying character — a character so uniform, that the description of 
the simple disease by Hippocrates, would graphically represent 
those cases seen by ourselves. For it is worthy of remark, that 
the practical history of intermittent fever was perfected by Hip- 
pocrates himself; that is, its external dcvclopcmcnts accurately 



1830.] On Intermittent and Remittent Fevers, fyc. 337 

marked — and even the names of its various forms, imposed by 
this great father of the science, are retained to this day. The 
question then, as to the pathology of this disease, becomes one 
of peculiar interest to the philosophical physician, since from this 
uniformity, it has presented a subject so favorable for investiga- 
tion — allowing the science of each succeeding age, to hold fast 
and establish those principles as to its nature, which were true, 
and gradually to discard those that were erroneous. In this 
point of view, its history is calculated to illustrate the powers 
and resources of the science. It may be interesting to trace its 
history in a very general manner, and to connect the opinions 
entertained as to its nature, with the prevailing philosophy of the 
most prominent systems ; for the fact, that we do not now under- 
stand its pathology, is well calculated to produce doubt as to the 
certainty of the science of medicine, after all the confident and 
boasted pretensions of these various systems to have explicated 
its nature ; which doubt will be removed by the conclusion to 
which we must necessarily arrive, that the science has not at- 
tained to this knowledge of its nature, because of the defective 
modes of its investigation. 

Hippocrates, with his admirable principles of forming medi- 
cine into a science of observation and of facts, with wonderful 
exactness, recorded the phenomena of this disease ; and if he had 
applied the same scrutiny to the interior of the human body, his 
theory might have been valuable — but what could be expected 
as to its pathology, from him, who understood not the difference 
between a ligament and a nerve, nor that these were the chan- 
nels of sensation ; who attributed motion to the agency of the 
tendons; who was ignorant of the circulation of the blood, and 
understood not the functions of the brain ? The philosophy of 
his age, had established the dogma of the existence of the four 
elements of nature, and in accordance with the spirit of the times, 
which was seeking for comparisons and strained analogies be- 
tween the universe and the human body, he established the dog- 
ma in medicine, that the body w r as composed of four humours, &c. 
and that diseases depended upon a super-abundance or deprava- 
tion of one or other of these. 

Author of the excellent principle of ever having some definite 
and specific object in view in the treatment of disease, his indi- 
cations in this instance, w T ere founded upon his pypothetical views 

43 



83S On Intermittent and Remittent Fevers, §c. [Nor, 

of its proximate and occult causes — viz. : to aid nature in the 
concoction and expulsion of the peccant humour. Such is the 
conclusion of him, who set out with the declaration, that obser- 
vation and just deduction are the only true means of advancing 
medicine. What a conspicuous example of the uncontrollable 
tendency of the human mind to vain and unprofitable speculation, 
do these views of this great man exhibit — apt prototype of the 
medical philosophers of all succeeding ages ! 

Galen, 500 years after him, his admirer and commentator, 
with greater exactness, attributed the quotidian form to the pre- 
dominance of the phlegm, tertian to that of the ordinary bile, 
quartan to the black bile. The opinions of Hippocrates, thus 
extended and stamped with the seal of this great master, contin- 
ued to control the minds of their successors to the time of the 
introduction of the system of chemical medicine. To give but 
one single example of their pathology : A celebrated partisan 
of this school, had determined very exactly, the composition of 
the globules of the blood to consist of phlegm, salt, sulphur and 
earth — that fever in general consisted in an unnatural fermenta- 
tion of these — and that intermittent fever especially, was gen- 
erated when the salino-acid and acrid principles, happened to get 
into the small vessels ! 

Whatever credit is due to the celebrated German reformers 
of the commencement of the 18th century, for overturning the 
chemical and humoral doctrines, their pneumatic system was 
calculated to establish nothing certain with respect to the inti- 
mate nature of this and other fevers. Stahl distinctly discoura- 
ages the application of physical and chemical science to medi- 
cine, and especially denounces the study of minute anatomy, 
lest it might lead men to the belief that disease sprung from 
changes in these delicate parts, and thus draw them away from 
the study of the great laws of the organization, and from an ex- 
amination into the alterations of the vital principle. We are 
not surprised at the deductions of this system as to the nature of 
fever — fancifully representing it to be a commotion of the sys- 
tem, excited by this active principle — this soul, thus roused to 
this extraordinary effort to free itself from an offending cause. 

In the " First Lines," — the text book of the elder of the present 
generation of medical men, we find this same mysterious agent, 
under the name of the vis medicatrix naturae, raised up to explain 



1830.] On Intermittent and Remittent Fevers, tyc. 339 

some of the changes in a paroxysm of intermittent. It is there 
characterized as "an agent," as "making efforts," — and we 
would suppose from the peculiar phraseology, that all the instances 
in which this supposititious power exerts itself, and even the modes 
of its operation, were well known to, and exactly apppreciated by 
the Edinburg professor — for there is this remarkable sentence, 
occurring too by way of argument in favor of his peculiar theory: 
" Because, in almost all the cases in which an effort is made by 
the vis medicatrix, a cold fit and a spasm of the extreme vessels 
are almost alu:aj/s the beginnings of such an effort"! — And after 
making this agent bear so conspicuous a part in his pathology, 
he arrives at the flattering conclusion, that "this doctrine will 
serve to explain the nature of fever in general," &c, and mod- 
estly congratulates himself upon having thus been led into "the 
proper train of investigation." 

An American critic* upon Dr. Cullen's theory of fever, ex- 
pressly avows his belief in the "existence" of this hypothetical 
agent, formally assigning to it functions; and he too, is well ac- 
quainted with its various offices, for after mentioning some, such 
as the knitting of fractured bones and the healing of wounds, he 
adds, " and many other processes which we cannot now enu- 
merate"! — He speaks of it as "a curative cause" In his opin- 
ion, it controls every thing, medicines and all — " were it not for 
its action, recovery from disease would be absolutely impossi- 
ble." After declaring that the reasoning of Dr. C. is " forced 
and artificial, unsatisfactory and confused," he asserts his belief 
with the fanciful Darwin, that fever is a disease of association — 
that it is formed alone through the medium of " sympathy."— 
We are irresistibly tempted to apply to this criticism, the re- 
mark of Dr. Johnson, upon some of Mr. Travers' speculations: 
"this is like casting out devils by Beelzebub the prince of devils." 

And even in the latest of those " Practices of Physic," with 
which our medical literature so much abounds ; in which one man 
attempts to develope the nature of all diseases in a general and 
superficial manner, instead of confining himself to the critical and 
philosophical investigation of one — those books that tell " Baith 
the disease and what will mend it," — and the popularity of which 
books we believe to be one of the causes of our lean and meagre 

* Professor Caldwell. 



840 On Intermittent and Remittent Fevers, <$-c. [Nov, 

attainments in medical science, by discouraging the printing and 
reading of Monographs— the " Practice of Physic" of M'lntosh, 
contains an illustration of the difficulty of putting down and 
keeping down this volatile serial spirit, which from Hippocrates 
even till now, under the names of "Nature," "Archeus," " The 
soul," "The vital principle," the "Vis medica,"and the "Vis med- 
icatrix naturae," has been called up, to cover with its imposing 
veil, the ignorances of the science. He says, "It is best to at- 
tribute the reaction of fever to the Vis medicatrix natures, which 
is ever in action to prevent injury and to remedy the evil after 
it has occurred." This remarkable sentence follows the formal 
declaration in the same paragraph, of "Acting upon the princi- 
ple of not enquiring into occult causes "! 

To those in and out of the profession, who are disposed to 
undervalue it from an examination into the history of opin- 
ions upon the nature of this disease, w 7 e would say : Shall it bear 
the reproaches, which are justly due only to those, who have so 
far departed from all true philosophy, and indulged themselves 
in this idle hypothesis-making? Who, instead of frankly and 
unreservedly acknowledging that they could not render a just 
and true account of it, have resorted to the agency of fanciful 
fictitious principles, thus contributing to the perpetuation of 
this false philosophy of occult causes, and to the stifling of judi- 
cious enquiry, by leading the minds of the young to rest in these 
false explanations. 

But the times of this scientific magic have passed away. The 
severe medical philosophy of the present day, basing itself upon 
the principle which lays at the foundation of both the science of 
physiology and pathology— that there is no action of the human 
system, healthy or morbid, that does not. result from the appli- 
cation of material agents acting upon the tissues of the system ; 
rejecting with utter abhorrence, the agency of any of these fan- 
ciful abstractions ; refusing to spend its high powers in investi- 
gating diseases of elementary properties and qualities ; question- 
ing the validity of every dogma, ancient or modern ; studying 
medicine as a physical science ; is seeking for the nature of dis- 
eases in the alterations of the tissues ; is patiently collecting facts, 
declaring that we arc not yet ready for the deduction of general 
principles to form a system. The celebrated disciples of this 
true philosophy in France and other countries, warned anew by 



1836.] On Intermittent and Remittent Fevers, cj-c. 341 

the ephemeral history of the commanding physiological system, 
of the danger of being too hastily betrayed into generalization, 
seem disposed to adhere with increasing faithfulness, to this only 
rational method of investigation — And accordingly one of the 
most eminent of the present French physicians, M. Rostan, au- 
thor of organic medicine, classes this intermittent fever among 
those affections, whose pathology is unknown; and calls it "the 
despair of organic medicine" ! — considering it hopeless ever to 
arrive at any certain and definite knowledge of the cause of in- 
termittence. This last conclusion, however, we cannot but re- 
gard as unphilosophical — it is a denial of the omnipotency of the 
philosophy of observation ; for who shall limit its discoveries, 
that regards the present state of the physical sciences, attained 
under its happy guidance ? 

We should not doubt that the accumulated observations of 
the present age, will discover some fixed and uniform physical, 
organic changes, upon which this singular disease depends, and 
thus arrive at a knowledge sufficient to guide us with a steady 
and satisfactory light, into correct principles of its treatment. — 
For we anticipate that this disease will claim in an eminent de- 
gree, the attention of the present generation; the pride of the 
science is concerned in explicating the nature of an affection 
treated so empirically, yet so successfully. 

Convinced of the importance of recorded facts, I have been 
induced to make from my note-book, a brief abstract of the fol- 
lowing cases, observed from the 23th July to the 1st of October. 

1. First visit, Ju.iy 2S. A negro woman, a3t. 40, of good habits, 
a washer — with a regular quotidian : suffering during fever, with 
distressing nausea and oppression of the precordia, sighing, and 
hurried, irregular respiration. Having suffered in December 
last an attack of colic, with excessive pain over the whole peri- 
toneal surface, but without effusion, and treated by cupping and 
blistering the spine, 1 was induced to examine it now, and 
found a remarkable degree of tenderness on pressure, at the 2nd, 
6th and 1th dorsal vertebrae — pressure there increasing the nau- 
sea and labor of respiration. She was cured by calomel — pur- 
ging, and subsequent use of quinine; sinapisms to the spine re- 
lieving nausea, when applied during the fever. 

2. August 4th. — A negro waggoner, aet. 30, suffered with bil- 
ious fever, according to his account, at Macon ; has been lip for 



342 On Intermittent and Remittent Fevers, $c. [Nov. 

a fortnight. Now has fever at night ; pain in the bowels and 
stomach ; pain on pressure over the whole abdomen ; regular 
stools; tongue slightly furred white ; diminished appetite; pulse 
not increased in frequency; general languor and anxious coun- 
tenance ; spinal tenderness at superior of the back. By gruel 
diet and a blister to the spine, the following day he was entirely 
relieved from pain, bearing the freest pressure of the abdomen ; 
appetite returned, and tongue clean ; countenance cheerful. 

August 10. After severe exercise, had a chill last night, fol- 
lowed by fever, which has declined. Now, same soreness of ab- 
domen ; yellowish-white furred tongue ; pulse 90, and soft ; some 
tenderness of dorsal vertebrae. After being purged freely with 
calomel, the soreness of abdomen unrelieved, on the evening of 
11th, had another chill with fever — but a lighter paroxysm than 
the first; the spine still tender on the 12th. A blister then re- 
lieved all soreness of abdomen and checked the chill without fur- 
ther medicine. On the 27th, while at work, was again taken 
with fever, and took calomel, &c. On the 28th, at 4 p. m., a se- 
vere ague, followed by fever. On the 29th, saw him — the ver- 
tebrae still sensitive on pressure ; a blister again checked the 
chill and he has had no further return. 

3. August 6. — A negro boy of 9 years ; irregular fever, after 
eating much fruit; no spinal tenderness. Relieved by emetic 
and purging. 

4. Negro woman, set. 25, of good constitution, uniformly 
healthy. Case of quotidian intermittent, accompanied during 
the paroxysm with great depression of spirits, weeping and sigh- 
ing, and distressing nausea and vomiting, with general soreness 
of the abdomen ; exquisite pain of the upper and middle dorsal 
vertebrae, on pressure. After purging with calomel, &c. ; cups 
with scarification of spine during a paroxysm, entirely relieved 
the nausea, vomiting and soreness, restoring her cheerfulness; 
and a blister to the spine arrested the disease. 

5. August 8. — A white boy, set. 16; delicate; six weeks 
since had chill and fever, which was checked by quinine. Six- 
teen days ago, was suddenly seized with violent pain in the right 
knee, which was relieved by stimulating applications ; the fol- 
lowing day, a chill, and since a regular double tertian. The 
7 or 8 superior dorsal vertebrae distinctly tender on pressure. 
On the decline of paroxysm to day, was purged with magnesia 



1836.] On Intermittent and Remittent Fevers, <$*c. 343 

and salts, and freely scarified and cupped on the spine, which 
was repeated on the 9th; and the chill, without the use of other 
means, was arrested. On the 17th and 18th August, he suiTered 
a paroxysm each day ; the spine still sensitive ; a blister checked 
the disease promptly, and he has since continued w T ell. 

6. August 15. — A mulatto boy, act. 16, a painter. This was 
a case of double tertian, characterized by excruciating pains du- 
ring the paroxysms, in the limbs and epigastric region. Ex- 
tremely offensive breath and heavily furred tongue ; and very 
great tenderness of the spine, from the third vertebra down. — 
Treated with calomel and oil, and cupping and blistering the 
spine, which brought it to the simple tertian form and much mit- 
igated the violence of the symptoms during the paroxysm ; the 
quinine was finally used, and on the 19th, he was discharged. 

7. August 14. — A female, set. 60 ; full habit ; has within the 
year past, suffered frequent attacks of colic, which have been 
uniformly relieved by blisters to the spine, which w r as always 
found sensitive. On the 12th, under strong moral excitement, 
was seized with a chill at 12 M., which was followed by intense 
fever. Took magnesia and salts, on the 13th, which operated well, 
and had no chill. 14th. Ague at 8, a. m. ; at 10 a. m. found her 
with flushed face, very loquacious, great fullness of head and 
confusion, tongue clean, bowels open, great oppression at the 
epigastrium, frequent sighing, pain in the shoulders, sides and 
bowels generally ; epigastrium very tender on pressure ; exqui- 
site pain on pressing 4th and 1th dorsal and 1st lumbar vertebrae. 
Three cups, with scarification to the spine, relieved the oppres- 
sion of the stomach and head signally, before the end of the oper- 
ation: which was followed by copious perspiration and relief to 
all pain ; she passed the night sleeping and waking alternately, 
in unusually quiet sleep, and great calmness when awake. Sin- 
apisms being repeatedly applied to the spine, and quinine taken 
for the two following days, there was no return of fever, and her 
general health since is very much improved. 

8. August 17. — This was a case of protracted remittent, a 
girl of 14; subject to monthly epistaxis, never having menstru- 
ated ; of a feeble constitution, &c. ; frequently renewed by im- 
proper diet, lasting to the 1st of September. Early in the dis- 
ease there was acknowledged sensitiveness of the 4th dorsal ver- 
tebra, but in frequent subsequent examinations it was not mani- 



#•14 On Intermittent and Remittent Fevers, fyc. [Nov. 

fest. It disappeared after copious diarrhoea, produced by eat- 
ing a tart. 

9. August 24. — Negro boy, aged 15 ; a race rider; has had 
repeated attacks of quotidian intermittent ; a paroxysm to-day, 
but he is now up and in good spirits; no tenderness of spine. 
Toast-water and gruel ; blister to spine drew before the usual 
hour of attack, and he has since escaped the chill. 

10. August 24. — Negro man, aged 30 ; carriage driver ; stout 
hearty looking fellow, enjoying ordinarily, perfect health. Chill 
and fever 22d ; 23d, fever at night ; 24th, at noon, slight fever ; 
head-ache and back-ache ; furred tongue white ; no tenderness of 
epigastrium ; very great tenderness of 4th, 5th and 1th dorsal 
vertebrae; was purged freely to-day; 25th, no tenderness of 
spine ; chill at 12 m. ; 20, still fever continued, increasing in the 
afternoon ; 6th and 1th dorsal vertebrae very sensitive ; oil as fe- 
ver declined, and blister to spine at n'ght. 27th, blister drew ; 
no fever. 28th, had light chill, (it was a cold rainy day.) follow- 
ed by very little fever. 29th, took quinine ; and subsequently 
had but one light paroxysm of fever. 

11. August 24.— Stout, healthy field negro, aged 25, has had 
from the 19th a double tertian, and on 22d took large doses of 
calomel and oil, which operated copiously ; this the day of the 
lighter paroxysm ; now 1 p. m., slight head-ache, tongue covered 
with thick, white furr, moist, no appetite; great tenderness of 
epigastrium, producing panting on pressure ; bowels open : great 
tenderness of the wltole dorsal spine, particularly of the lower re- 
gion and of the last cervical ; free pressure produces great dis- 
tress, and particularly, irregular respiration. No medicine, nor 
*ood; blister six inches long to spine. 20th, blister drew well ; 
pain of abdomen on pressure, none, except at the epigastrium ; 
expresses a sensation of great relief from the time of drawing of 
the blister. Toast water, and a small blister to epigastrium. 
The following day his appetite was imperious ; tongue clean ; 
no pain, and walking about. 

12. August 28. — A gentleman, aged 50, of good general health 
and habits; unwell generally on the 24 and 25; fever on night 
of 25 ; 26, chill at 5 p. m. and yesterdny at the same hour ; suf- 
fered a violent paroxysm of fever last night, has dieted closely ; 
oil yesterday, producing great prostration after each stool ; this 
morning, at 10, is setting up; no pain, no cough, no tenderness 



1S3G.] On Intermittent and Remittent Fecers, <J-t\ 345 

of epigastrium; pressure upon the 5th, 6th, 7th dorsal vertebrae 
producing exquisite pain, forcing groans from the patient ; no 
medicine ; gruel diet. Blister immediately to spine, six inches 
by three, which drew in four hours. No chill or fever to-day, 
but comfortable night and sense of great relief generally. 29th. 
Sinapisms were ordered to spine, above and below blistered sur- 
face at 3 p. m. — but the chill returned at 12 m., the fever being' 
much lighter than formerly, and underwent the operation of oil 
on the decline of this paroxysm without any unusual debility. — 
He subsequently took quinine and had light paroxysms in the 
nights of the 30th and 31st. The tongue becoming very foul, 
on the 31st, took calomel, which operated freely. Sept. 1. This 
morning, without fever, the tongue was furred and the !eft half 
very dry ; but this was evidently owing to the loss of the left 
lateral incisor and stomach teeth, at which aperture the air en- 
tered in breathing. He took quinine freely to-day, and had af- 
terwards but one light paroxysm of fever without chill. 

13. Aug. 30. Negro boy, set. 12; has had Intermittent fever 
for three successive summers. Has now had four paroxysms. 
Second and sixth dorsal vertebrae tender slightly ; a blister and 
quinine after a cathartic relieved him promptly. 

14. Aug. 30. — A hale, strong negro man; chill yesterday at 
12 m. ; second, sixth and seventh dorsal vertebrae sensitive on 
pressure. Oil and a blister to the spine. No more chill or fever. 

15. Sept. 1. — A young man, set. 20, a close student. This 
was a case of remittent fever, with daily exacerbations in the af- 
ternoon, preceded by a momentary chilliness sometimes — accom- 
panied with severe head-ache, but without any trace of spinal 
tenderness. Treated by bleeding ; calomel and oil, and quinine 
in the remissions, terminating on the sixth ; the durations and vi- 
olence of the paroxysms gradually diminishing. 

16. Sept. 3. — A gentleman, act. 30; of full habits, dark skin, 
and phlegmatic temperament, good habits; has had three par- 
oxysms of anticipating tertian; suffering with the paroxysm to- 
day, most distressing nausea ; fifth and sixth dorsal vertebrae 
quite sensitive: having taken calomel yesterday, the bowels were 
open. Blister applied to the spine drew well, and he took qui- 
nine the following morning. He had no more chill, but irregular 
fever until 8th — having been treated in the intermissions with 
calomel and quinine. 

44 



346 On Intermittent and Remittent Fevers, $c. [Nov . 

17. Sept. 3. — A single female of bad habits, get. 21 ; but good 
general health, and regular menstruation. Has had a paroxysm 
of intermittent to-day ; one yesterday. Saw her in the sweating 
stage ; eighth and ninth dorsal vertebrae sensitive on pressure ; 
was purged freely to-day and blister applied to spine ; the fol- 
lowing day no paroxysm, was ordered quinine ; but did not take 
it with any regularity ; had return of chill for two or three days, 
when finding it impossible to make her take medicine, the case 
was abandoned. 

18. September 4th. — A negro woman of good constitution 
and general health; had a chill yesterday followed by fever; 
saw her without fever ; the dorsal vertebrae from the second to 
eighth sensitive on pressure. A mercurial cathartic acted brisk- 
ly on the bowels, and she had no return of chill ; some fever the 
following night. 

19. Sept. 5. — A boy, set. 10, in the country. Chill on the 31st, 
followed by fever remitting daily ; every second day the fever 
more violent, but represented as never entirely free from it. — 
Took 10 grs. calomel last night, six copious black stools; com- 
plete apyrexia to-day ; fifth, sixth and seventh dorsal vertebrae 
very tender on pressure. Blister to spine ; saw him on the 8th, 
at 8 a. m., has had two severe paroxysms of fever, but no chill : 
involuntary micturiction ; stupid, with difficulty aroused ; pulse 
110; skin pallid and damp; bowels have been kept open by oil: 
tongue very dry and red; took 10 grs. quinine during the day, 
and at evening was less lethargic ; the tongue moist, red at edg- 
es, white in the middle. 9th, 12 m.; no stool ; this morning was 
reported to be free from fever, and took 5 grs. quinine ; now ve- 
ry restless and sighing; pulse 120; skin hot and dry; tongue 
very dry and hard ; has coughed once or twice to-day ; evidence 
of bro- ' iti.3, on examination with stethoscope ; no tenderness of 
epigastrium ; 1-8 gr. tart, antimony every hour, to be discontin- 
ued on purging. From this time this patient began to improve, 
the fever gradually abating, and was discharged on the 14th con- 
valescent. 

20. Sept. 5. — Boy six years old; has had a quartan inter- 
mittent for four weeks, the chill coming on exactly at sun-down. 
No fulness of abdomen ; good appetite ; regular bowels ; com- 
plexion fresh; no spinal tenderness on the freest pressure; chill 
expected 4o-morrow ; no medicine ; blister six inches long to 



1836.] On Intermittent and Remittent Fevers, $c. 847 

dorsal spine to-morrow at 11 a. m. It drew speedily ; he had 
no chill, but a very light fever for two or three hours during the 
night. The following day of attack, sinapisms were applied to 
parts of the spine not occupied by the blister; and he had only 
a light fever. Subsequently he has taken quinine, and recov- 
ered. 

21. Sept. 5. — Boy 12 years of age; a dirt-eater, white skin, 
transparent ears, tumid abdomen, enlarged spleen; has had sev- 
eral paroxysms of a tertian; has considerable tenderness of the 
5th and 6th dorsal vertebrae ; has taken oil. A blister to spine 
did not arrest it; and quinine was added to the treatment. 

22. Sept. 5th. — A girl, aet. 13; of good general health; has 
had two paroxysms of fever, without chill; slight chill to-day, 
and two light chills on the following successive days ; treated 
with cathartics and quinine. Examined on the 6th, there was 
no spinal tenderness ; but on the 8th, there was slight uneasiness 
felt on pressing the fifth dorsal ; and on being discharged, the 
same degree was still perceptible. 

23. Sept. 9th. — A dirt-eating girl, about 9 years old; apyrex- 
ia now ; is represented to have had irregular fever, with one chill, 
for six days. Has taken castor-oil ; sixth and seventh vertebrae 
very sensitive. Blister and quinine to-morrow. Instructions 
being neglected, the following day dismissed myself from the 
case. 

24. Sept 12. — A carpenter, set. 25 ; robust and strong, and 
generally healthy. 8th, chill at 4 p.m.; 9th, fever rising at noon, 
without chill; 10th, up early, without fever; at 7 a. m., severe 
ague ; 1 1th, perspiring in the morning; fever rose at noon, with- 
out chill ; ague to-day at 7 a.m.; has taken pills to-da} , .oba- 
bly of lobelia, sent by the Steam Doctor, which haio vonited 
him copiously. Fever now declining ; fifth, sixth and seventh 
dorsal vertebrae extremely painful on pressure. A blister to the 
spine and quinine in two grain doses, checked the disease after 
one more light paroxysm. 

25. Sept. 12. — A married female, aet. 30 ; of good general 
health. A case of irregular intermittent, with no remarkable 
symptom ; tenderness of dorsal vertebrae. Fever checked prompt- 
ly, by blister and quinine, after a dose of oil. 

26. Sept. 14. — This was a case of irregular tertian in a girl 
of 1 1 years of age ; fourth, fifth and sixth dorsal vertebrae ex* 



. 348 On Intermittent and Remittent Fevers, <$-c. [Nov. 

tremely painful on pressure ; promptly relieved by oil, a blister 
and quinine. 

27. Sept. 14. — A girl 11 years of age. To-day had second 
paroxysm of a tertian ; fourth, fifth and sixth dorsal vertebrae 
very tender; oil, blister-plaster and quinine, &c. Directions 
were disobeyed ; had a paroxysm on the 16th, when blister was 
applied and quinine irregularly taken ; only one more paroxysm. 

28. Sept. 16. — A strong athletic negro man, 25 years of age. 
After two days of indisposition, has had two paroxysms of chill 
and fever on successive days; exquisite tenderness of fourth, 

fifth and eleventh dorsal vertebrae ; a blister and quinine in 2 gr. 
doses, put a period to the disease immediately. 

29. Sept. 16. — A widow, aged 50; hysterical, habitually co- 
pious urine and pain in region of kidnics. On the 10th had an 
eruption of urticaria, with nausea; oppression of epigastrium; 
has since been feverish at night. This morning an ague of an 
hour's continuance, followed by fever, and the most excruciating 
pains in all the limbs and sides and back ; compared to the ham- 
mering of Jhe bones. Great oppression of stomach and chest; 
frequent sighing; fourth, fifth and twelfth dorsal vertebrae exqui- 
sitely painful, on pressure and percussion. Sinapism to spine, 
during fever, abated the violence of the pains ; oil on decline of 
fever. Two blisters to spine at night, and quinine in 3 gr. doses, 
prevented a return. She sufFered intense head-ache on the night 
of the 18th, which I attributed to the use of quinine during the 
day. 

30. Sept. 16. — Negro boy, aged 14. This was a case of re- 
mitting fever, in which there was no sensitiveness of any part of 
the spinal column. Treated by V. S. and calomel purging and 
quinine in the first remissions. About the sixth day, the fever 
increasing in violence, with intense head-ache and delirium, dry 
tongue, &c. After a second bleeding, and blister to dorsal spine, 
the case was soon terminated favorably. 

31. Sept. 18. — A widow, aot. 50 ; general health not very 
good; hysterical. Has had three paroxysms of a tertian; one 
this morning. Fever now declining ; fifth dorsal vertebrae very 
tender. Calomel and oil, and blister and quinine, prevented ano- 
ther paroxysm. 

32. Sept. 18. — A single female, ast. 25 ; of regular menstrua- 
tion ; but for four years has sulfered pain in the left hypochondri- 



183C] On Intermittent and Remittent Fevers. <S,c. 349 

urn, which has been greatly increased during every paroxysm of 
fever. Fever every afternoon since 15th ; chill to-day at 1 p. m. ; 
fifth, sixth and sevenlh dorsal vertebrae very tender on pressure. 
15 grs. calomel; blister to spine at night and quinine in the morn- 
ing. There was no return of chill ; the fever preserved a re- 
mitting form ; and under the use of quinine in two grain doses, 
during the remission, with oil occasionally, the fever gradually 
became lighter and of shorter duration, until the 23d, when she 
was discharged. She continued well until the 29th ; had a chill 
in the morning after a feverish night ; saw her in decline of fever ; 
found the third, fourth and seventh dorsal vertebrae, (examined by 
percussion,) exquisitely painful. Scarified and cupped the spine 
freely at 9 p. M., the fever having entirely abated. Ague on the 
morning of the 30th, at day-light, followed by fever, which de- 
clined in three hours. Tongue moist and but slightly furred, 
yellowish white ; foul taste in the mouth ; bowels open. Cups 
reapplied to spine, and enjoined rest and low diet ; at night had 
high fever, with distressing pain in region of the spleen. Octo- 
ber 1st. — In the morning without fever ; eyes very yellow, and 
bowels confined. Prescribed three calomel and aloes pills, of 7 
and 2 grs. each ; one every three hours ; these produced very 
black consistent discharges, and since the fever has ceased. Ten- 
derness of spine still continuing, was discharged with advice to 
apply a blister thereto. 

33. Sept 19. — A healthy young man, of active habits, has suf- 
fered a daily paroxysm of intermittent since the 16th, and has 
taken much simple cathartic medicine. The seventh dorsal ver- 
tebrae is sensitive, manifestly, on pressure. Declining the blis- 
ter, the quinine relieved him speedily. 

34. Sept. 4. — A negro woman, set. 45. After three or four 
days of irregular feverishness. with loss of appetite, had chill to- 
day, followed by fever. Xo\v great depression of spirits; fre- 
quent sighing and weeping; nausea; great oppression at the 
epigastrium ; tongue thickly furred white ; seventh, eighth and 
ninth dorsal vertebrae extremely sensitive. Copious draughts of 
warm water to produce vomiting, with sinapism to spine, soon 
relieved her most distressing symptoms. I saw her onlv in this 
emergency, in the absence of the family physician. 

35. Sept. — A robust female of short stature, act. 22 ; of 
regular habits and good health. She suffered four paroxysms of 



350 On Intermittent and Remittent Fevers, tyc. [Nov. 

quotidian, of a malignant character ; during the fever the whole 
of the limbs remained cold, and the hands red ; the pulse very 
rapid and compressible ; great oppression of epigastrium ; labo- 
rious, hurried respiration ; great anxiety and thirst ; tongue dry ; 
warmth gradually returning to extremities at the end of parox- 
ysm, when the pulse became more full, but always very com- 
pressible. She was blistered on the spine ; took large and re- 
peated doses of calomel, with quinine in 4 gr. doses, during the 
imperfect remissions, with blisters successively to spine, legs, 
stomach and arms ; and after the bowels were opened by the 
calomel, morphine in 1-8 gr. doses, every two hours during the 
fever. After these four paroxysms, the reaction became general 
in the next paroxysm of fever, which was without chill on the 
28th ; took no more quinine, still complaining of great oppres- 
sion of epigastrium and hurried respiration. 28th and 9th, took 
40 grs. of calomel in divided doses, with morphine after its ope- 
ration. 39th, 5 p. m. — Skin very hot, with exception of the fin- 
gers, which are cold, the ends extremely cold; pulse 128 undu- 
lating, full, very compressible ; tongue rough and dry ; blister to 
spine well, sufficiently to allow examination by percussion ; 
light percussion as well as pressure of the first to fourth dorsal 
vertebrae produces instantly a hacking cough — which is renewed 
by every examination — and at intervals of two or three minutes, 
was frequently repeated. Examination with stethoscope disco- 
vers respiration natural ; two scarifications on spine, and cups 
applied for half an hour, drew about 2 ozs. blood. Before the 
cups had been on ten minutes, the fingers were as warm as other 
parts of the surface ; at the end of the operation, expressed a 
sense of relief to the distressing oppression of the epigastrium. 
The night was passed generally in quiet sleep, without anodyne. 
October 3. — Distress in stomach still continuing, was cupped and 
blistered at the epigastrium on the 2d, and bowels opened by oil ; 
and to-day is much relieved ; asks for some nourishment and is 
impatient at its delay. Discharged on the Gth convalescent. 

3G. Sept. 28. — Negro boy, a?t. 8. Is represented to have had 
fever every afternoon and night since the 25th, without chill ; 
has taken oil ; at 8 p. m. to-day, skin universally hot ; tongue 
heavily furred, yellowish white ; pulse frequent but soft ; fre- 
quent sighing and spasmodic breathing when awake ; head con- 
fused on being waked up ; second, third, sixth and seventh dorsal 



1836.] On Intermittent and Remittent l'f.vers,<yc. 351 

vertebrae exquisitely painful on pressure ; which produce* griev- 
ous complaints, and increases the difficulty of breathing ; oil; 
blister to-night on decline of fever, and quinine in morning; 2 gr. 
doses. 29th, 10 a. m. — Many stools ; blister drawn ; has taken 
four doses quinine : has no liver. This patient in the afternoon 
was removed to his owner's house and passed from my care. 

37. Sept. 26th. — A boy of 10 years, with large head and exer- 
cised brain ; has had remitting fever for three or four days ; has 
taken oil, which has operated but slightly. 7 i\ m. — Head-ache, 
ear-ache, flushed face ; pulse 100, full and compressible ; skin hot ; 
lips very red ; tongue furred, brownish white and moist ; breath 
offensive ; slight uneasiness at epigastrium on pressure ; second, 
third and seventh dorsal vertebrae very sensitive, the patient shrin- 
king from pressure and percussion. 16 grs. calomel in two doses, 
followed by oil in the morning, with blister plaster at bed time to 
spine and quinine the following day, arrested the fever. 

39. A female of delicate constitution, about 30, nursing an in- 
fant of six weeks old. Had cholera morbus on the 22d, from 
some improper article of diet, and fever at night. After the op- 
eration of 15 grs. calomel, taken in three doses, on the 23d had 
fever at night. During morning of 24th, took five grs. of quinine, 
and in the afternoon and night had a paroxysm of fever, with most 
distressing nausea and vomiting, and excessive arterial excite- 
ment ; the nausea was relieved by peach-leaf tea. After this, 
the bowels being kept open by magnesia, the quinine being taken 
freely during the remissions, the paroxysms gradually became 
lighter until the 30th., when she was discharged. The paroxysm 
every other day was much more violent. The tongue was per- 
fectly clean throughout. Examined twice, the dorsal spine was 
sensitive. This patient experienced the greatest relief from the 
use of ice during the fever. 

40. Oct. 1. — Laborer, act. 40, of intemperate habits, but ro- 
bust and healthy. Fever at noon of the 29th ; 30th, nausea and 
vomiting all day : fever at night ; this morning ague at day-light. 
Fever now declining ; violent head-ache ; tenderness of epigas- 
trium ; tongue much furred, yellowish white ; no stool to-day. 
The lower cervical vertebrae, and five or six upper dorsal, and 

fourth and fifth lumbar vertebrae, very sensitive on pressure and 
percussion. No other medicine at hand, took 20 grs. calomel. — 
Blister plaster six inches long to spine : quinine in 2gr. doses to- 



353 On Intermittent and Remittent Fevers, fyc. [Nov. 

morrow. Medicine operated freely, and in the morning was 
entirely free from fever, taking quinine without inconvenience. 

The foregoing are not selected cases ; but they are all, the par- 
ticulars of which I have recorded, within the above named dates. 
Besides these, I have memoranda of other cases of fever, sim- 
ply with respect to the presence or absence of this particular 
spinal tenderness, viz. : Seven cases of remitting fever in which 
it was present ; two in which it was absent ; and four of inter- 
termittent, present in all. I cannot forego the satisfaction of ad- 
ding the two following observations furnished me by my friend, 
Dr. Joseph Milligan, illustrating so conspicuously the influence 
of spinal irritation in remitting fever, and the happy consequen- 
ces of directing the treatment to its reduction. 

" Bob, a stout negro fellow of 24 years, was attacked with re- 
mittent fever, about the middle of June, 1836. When I saw T him, 
about twenty hours after his attack, his pulse was full, strong and 
hard (about 100 in frequency,) and the tongue was red and furr- 
ed. He complained of great pain in the back, intolerable head- 
ache, and the conjunctiva was much reddened by the fulness of 
its vessels. He had taken a dose of castor oil before I saw him, 
which had operated, without relieving him in any degree. I bled 
him from the arm immediately, in a recumbent posture, (a severe 
vertigo preventing him from sitting up.) and was surprised to 
see him faint from the loss of not more than three or four ounces 
of blood. I prescribed twenty grains calomel, which was fol- 
lowed next day by a dose castor oil. No other medicine than 
the oil was given on that day. But on the next, finding no abate- 
ment of the head-ache, nor other change for the better, in this con- 
dition, I bled him again as he lay in bed and had his feet plunged 
in hot water. Again he was about to faint, when no more than 
three ounces of blood had been drawn, and I stoppedthc flow. — 
I was perfectly at a loss to conceive, how under the existing ex- 
citement of the brain, syncope should follow so light an abstrac- 
tion of blood ; for on former occasions I had bled him, and he stood 
pretty large bleedings very well. The pain in the back was so 
great that he could not turn himself in bed but with great effort; 
and he chose the supine posture as affording the greatest relief 
to the spine. I resorted to a variety of means to mitigate his 
sufferings for two days longer, at the expiration of which time he 



1836.] On Intermittent and Remittent Fevers, <J*. 853 

did not seem to be a whit the better for all that I had done for 
him. It now occurred to me that it would be well to examine 
the spine, for the purpose of discovering whether or not there 
w< re any tenderness, in any part of the column. I commenced 
at the back of the neck, and seizing each vertebra successively by 
the spinous process, moved it laterally with a slow but firm mo- 
tion, until I arrived at the lumbar region. He did not experi- 
ence any p iio (Turing this operation, until I had reached the first 
or second lumbar vertebra, as well as I remember, when he shrunk 
in great pain, from beneath my hands; and as I repeated the ex- 
amination at the sensitive spot, to be assured of the condition of 
the parts, he cried out that the motion gave him great pain, "ve- 
ry severe." I scarified the skin deeply on each side of the pro- 
cess of the vertebra affected., and succeeded in drawing, proba- 
bly, two ounces of blood. The part was then covered with a sina- 
p'sm, wliich was allowed to remain there for a half hour. In a 
few hours the pain in the back and head-ache were gone. Next 
day, the tongue began to clean off; and in forty-eight hours he sat 
up, comfortably. From tliis time his convalescence was rapid. 

Mrs. , in the seventh month of her pregnancy, was ex- 
posed to a shower of rain on the 4th July, and a week after, was 
attacked with remittent fever. The exacerbations, as usual, 
occurred at noon, and the remissions towards morning. The sto- 
mach was irritable during the progress of her disease, and only 
ceased to be so, when she became decidedly convalescent, but 
the tongue was soft and almost clean, and exhibited none of the 
appearances which we are accustomed to see, in most cases of 
gastric excitement. The matter vomited was generally a de- 
praved bile, often bearing a striking resemblance to the acet. cop- 
per, in colour. On the first day of the attack, there was consid- 
erable head-ache, which was promptly relieved by a moderate 
bleeding. She was treated with calomel, followed by laxatives 
pro-re-nata. After the removal of the head-ache, no local pain 
was complained of, until about the tenth or twel th day, in the 
forenoon, when she suffered severely from a pain in that region 
of the right side, comprehended between the mamma and the last 
of the false ribs. A sinapism over this part did not mitigate her 
suffering in the slightest degree; and as there was no reason to 
believe, from existing circumstances, that the liver was specially 

45 



354 On Intermittent and Remit tmt Fevers, <$*c. [Nov, 

implicated, the vertebrae were examined, for the purpose of deter- 
mining the condition of the spinal chord. At the third dorsal ver- 
tebra, a good deal of soreness was experienced by the patient, 
upon pressing its spinous process. A sinapism was applied over 
this part, and its action on the skin was followed by the instant 
departure of the pain in the side. It recurred however, in the 
evening, as the sinapial excitement diminished. The part over 
the vertebra affected, was then freely scarified, and an ounce or 
two of blood extracted by cupping. This operation was succeed- 
ed by immediate, complete and permament relief. 

The fever began to abate soon after; and had not the condi- 
tion of the uterine system kept up a certain degree of irritability, 
the patient would undoubtedly have experienced no further incon- 
venience from fever. She was perfectly restored to health on. 
the 10th August, s 

J. M." 

It thus appears, that of these forty cases of intermitting and re- 
mitting fever, this tenderness on pressure, of same portion of the 
spinal column, was present in all, but four cases of remitting fe- 
ver, viz : Nos. 3, 15, 22, 39 ; and in two cases of intermittent, 
viz. : Nos. 9 and 20 ; but of these, however, one was arrested by 
a blister to the spine, without other m^ans used, but dieting ; and 
the other was modified materially, in its character, in like man- 
ner. Although I would not presume to estimate the degree of 
influence of the topical applications to the spine, when used con- 
jointly with other remedies of acknowledged power in these dis- 
eases, still we cannot but conclude, from the very conspicuous 
relief afforded by them, in many of the cases, when used alone, 
that in the other cases they must have exerted no inconsiderable 
influence; and I think I am warranted in the assertion, that un- 
der this treatment, the cases of intermittent were more promptly 
arrested, than they generally are when treated with quinine 
alone. 

On the statement of these cases, with so remarkable uniformi- 
ty of this one symptom, the first question which naturally pre- 
sents itself to the mind of every one, is — Have the observations 
been justly made? Not implying any suspicion of the honesty 
of the observer; for strangers shall account him honest, upon the 
general consideration, that he is a member of an honorable pro- 



1830.] On Intermittent and Remittent Fevers, ^-c, 355 

fession ; but he may have been deceived — his method of exami- 
nation may have been defective — pressure of the skin between 
the finger and any bone, may produce pain and uneasiness. I 
therefore state particularly the mode of examination. Commen- 
cing at one or other extremity of the column, I press with an 
equal degree of force, directly upon each spinous process, calling 
the attention of the patient forcibly, to the degree of uneasiness 
felt upon the application of the finger to each point, and begging 
him to compare these sensations together; where practicable, as 
it is in the majority of cases, depressing the skin on each side of 
the spine, as low as possible by the thumb and finger, so as to 
include the spinous process between them, and move it alter- 
nately, in one and the other lateral direction. But the most sat- 
isfactory mode of examination is by mediate percussion, to 
which I was led by the desire to examine the vertebrae, over 
which a sinapism or a blister had been recently applied, and pro- 
duced an inflammation of the skin, thus rendering the examina- 
tion by pressure, manifestly improper ; because the results could 
not be fairly compuvd with those obtained by pressure upon 
•other vertebrae, over which the skin was entire. The medium I 
have used is the middle finder of the left hand; placing the ball 
directly up m the process, and making the impulse upon the nail, 
with the middle finger o r the right hand. I say upon the nail — 
thereby conveying the assonance, that the impulsive force has not 
been unduly violent. I would here suggest the caution, not how- 
ever by way of heightening and magni y a? the importance of 
this subject, but from a conviction of the practical importance of 
the suggestion, that this percussion be made upon each vertebra 
at first, very gently, for in many instances, the distress to the 
patient produced by it, is extreme. Other media might be sug- 
gested, but I consider the finger superior to every other in this 
respect, that we judge with the most unerring exactness, when 
the impulse is and is not communicated directly to the whole 
vertebrae ; and if we discover that it is applied obliquely, with the 
m >st perfect case we can, by varying slightly the position of the 
finger, accomplish our object Another advantage of this exami- 
nation by percussion, I have already hinted at, that it may be ac- 
complished even upon a recently blistered surface. 

Another question naturally presents itself— what is the force 
and value of this symptom ?-~ whence this uneasiuess ?-r-what 



356 On Intermittent and Remittent Fever*, fyc. [Nov. 

does its existence indicate? Certainly not that the skin at these 
particular points is sore and tender ; I have endeavored careful- 
ly to verify this fact, by taking it up between the thumb and fin- 
ger and compressing it with more force than was applied by the 
direct pressure; uniformly receiving the assurance of the patient, 
that the uneasiness was of a different character from that pro- 
duced by pressure upon the bone. But if this might be the cause of 
pain, in the method by pressure, it cannot be in that by percus- 
sion ; for it is well known to those who make use of mediate 
percussion, that it may be employed freely, even upon a blistered 
surface, without producing pain. It as certainly does not indi- 
cate that the bone itself is tender and diseased; for we cannot 
conceive why pressure upon a diseased bone, should be followed 
by sighing, coughing, increased oppression of the precordia, nau- 
sea and faintness. It is as unsatisfactory for the same reasons, 
to attribute this symptom directly, to a diseased state of the liga- 
ments of the vertebrae. 

Having thus excluded these three parts from any participa- 
tion in the production of this phenomenon, we next enquire — Can 
it proceed from a diseased state of the dura mater lining the bo- 
ny channel? We answer unhesitatingly, that the symptoms a- 
bove referred to, developed in distant organs by the examination, 
cannot arise directly, from an inflammation or anv degree of irri- 
tation of the dura mater, for reasons assigned already; but we 
can conceive very readily, how the dura mater, being in a swol- 
len state, might produce such symptoms, by compressing t\n> or- 
igin of nerves supplying these distant organs, when an unusual 
degree of motion is communicated to the vertebrae by percussion. 
But we perceive that this unusual motion oi'lhe v( rt; l.ra would 
produce the same degree of pressure, if the dura mater were in 
its normal state, and the substance of the chord il self enlarged. — 
We therefore must, necessarily, adopt the conclusion, that this 
phenomenon indicates a diseased state, either of the medullary 
substance of the spinal chord, or of its investing membranes. 
I am not prepared to infer from th< se few cases, that this local 
affection of the spine always exists, nor that it is the primary irri- 
tation upon which these fevers depend; but if subseqm n! obser- 
vations shall establish the uniform existence of this spinal irrita- 
tion, at the commencement of intermitting and remitting fevers, 
it will confirm the* opinion now almost universally held by the 



1836.] On Intermittent and Remittent Fevers, $e. 3 37 

profession, of the local origin of all fevers, and the equally uni- 
versal persuasion, that this location is in some part of the nervous 
system. 

I shall barely, in conclusion, suggest some considerations cal- 
culated to raise the presumption at least, that this local disease 
may account for many of the phenomena of these fevers. 

First. I consider it established beyond all controversy, both by 
direct facts and reasoning, that rheumatism is of spinal origin. 
Without entering into any particulars, I take great pleasure in 
referring to an article on this subject, by Dr. Dugas, in the first 
number of the Southern Medical and Surgical Journal. 

Second. Ordinary colic is uniformly attended with the evi- 
dence of spinal irritation, and I am ready to assert from my own 
experience, that more conspicuous relief is obtained in this dis- 
tressing affection, from topical applications to the spine, than 
from any other mode of treatment. 

Third. Colica Pictonum, it is certain, is not a disease of in- 
flammation at the seat of pain, for it is treated with success by the 
most violent and drastic cathartics — a course well calculated to 
aggravate the disease, if it depended on local inflammation. 
On the records of La Charite, there are more than five hundred 
cases treated in this manner, and five fatal cases — in neither of 
which, were there but slight traces of local disease in the bowels; 
and two in which there was a collection of fluid in the arachnoid 
of the spine, and in one of these, softening of the dorsal portion of 
the marrow. In the record of these cases, no mention is made of 
examination of the spine during their course, this mode not then 
being in use. M. Andral establishes the conclusion, that this dis- 
ease depends upon lesion of the spinal marrow and abdominal 
plexus of the great sympathetic, and that the- constipation de- 
pends either on paralysis of the muscular coat of the intestines or 
suspended secretion of intestinal mucus. 

Fourth. Asthma — This affection for 3 years past, I have found 
almost constantly, accompanied with spinal tenderness, and 
promptly relieved by cupping and blisters. 

Fifth. I can apply the preceding remark to Hysteria, with 
its almost infinite variety of symptoms. 

Sixth. The records of medicine, recently, contain many cases 
of intermittent neuralgia in distant parts, co-existing with spinal 
irritation, and promptly relieved by topical applications to the 



358 On Intermittent and Remittent Fevers, tyc. [Nov. 

spinal column. I refer to two conspicuous cases in Teale's work 
on neuralgic diseases. 

Seventh. The same work contains cases in which pulsations 
in the epigastrium, tightness across the epigastrium, great mus- 
cular debility, disorder of the secretions, palpitations, tremors, 
flatulence, pyrosis, &c. &c. &c, existed simultaneously with the 
evidence of spinal irritation, and were relieved by its treatment, 
even when there was reason to believe, they were accompanied 
with a diseased state of the sympathetic gauglia. 

These considerations, shewing the intimate connection in par- 
ticular cases, between spinal irritation and diseased function of 
almost every tissue in the body, together with the fact of the in- 
termittency of those diseases called nervous, are calculated I say, 
to raise the presumption, that the phenomena of these intermitting 
and remitting fevers depend upon a local or general diseased con- 
dition of the spinal marrow. 

If this local affection of the nervous system does exist in these 
fevers, can the fact be established by autopsic examination, and 
why has it not been thus ascertained before this ? I answer that 
possibly, in this way the fact of this disease and its nature may be 
revealed, by the dissection of subjects that die of casualties, while 
in the early stage of these fevers; but it is very obvious, that the 
absence of organic lesion of this portion of the nervous system, in 
cases fatal after a protracted course, is no evidence whatever 
against its existence at their commencement ; because, on the 
presumption that the most distinctive, characteristic feature of 
these affections, their intermittency, depends upon this local irri- 
tation, it would be unreasonable to expect to find it, after the fe- 
ver had lost this character — universally the case, as it advances 
towards a fatal termination. Again. — These fevers are treated 
by some practitioners, with drastic cathartics, by others with re- 
peated doses of calomel, on the belief of their hepatic origin ; both 
we suspect, relieving this local affection, on the principle of revul- 
sion ; in the same manner, it may be, and no doubt is resolved by 
the predominance of serious affections of other organs arising in 
the course of the fever. My limits will not allow to add but a 
tingle illustration of this principle. How often do we see gastri- 
tis existing in fever, so unequivocally, that the judicious practi- 
tioner withholds all active and irritating medicines from the sto- 
mach, and uses his utmost endeavors to arrest it, believing that 



1836.] On Inteiinittent and Remittent Fevers, fyc. 359 

upon its reduction depends the safety of his patient — we see this 
gastritis often, relieved in the course of twelve or twenty-four 
hours, by the development of bronchitis — so entirely cured, as to 
permit the free use of antimonials,to overcome the bronchitis ; but 
if this patient should die of suffocation, from bronchitis, who ex- 
pects to find organic lesion in the stomach? Will the practi- 
tioner doubt the fact of the previous existence of gastritis, from 
its absence? 

I must add on this subject, the declaration of M. Andral, that 
in fevers called essential, there is no nervous symptom but may be 
manifested without appreciable alteration of the brain and its ap- 
pendages. 

I have so far transgressed the limits assigned me, that I add 
but one or two remarks on the treatment of these fevers. 

In the first place, we infer the propriety of the early use of re- 
vulsive applications to the spine; leeches, cups, sinapisms or blis- 
ters — one or other of these, according to the w r ell established 
principles regulating their use. 

If this affection of the spine be the original irritation upon 
which all the other phenomena of intermitting and remitting fe- 
vers depend — which determines their individuality — then we 
may with the more confidence, at their commencement, make 
free use of cathartic medicines in general, and particularly of 
calomel, a medicine of so much power in correcting the disor- 
dered secretions of the abdominal and thoracic organs: for in- 
stead of being deterred from their use, by the apprehension of ex- 
citing infl lmm ition in the stomach and bowels, alreadv exhibiting 
functional dcra lgement. this pathological view will sanction their 
use, to accomplish a two-fold intention — to relieve the original 
affection, by their revulsive operation, and to remove the conges- 
tion and those depraved secretions of the abdominal organs, 
which are generated by every paroxysm of fever — which conse- 
quences, if long neglected, may determine a pathological condi- 
tion of these organs, and destroy the periodicity of the fever. — 
So far (rem being led to a treatment directed only to the spi- 
nal column, to the exclusion of ordinary modes, we consider this 
legitimate deduction from the pathology we have suggested, of 
the highest practical importance. 

The unvarying experience of nearly two hundred years attests 
the eilicacy of Peruvian bark and its more valuable, refined, mod- 



300 Remarks on use of Quinine in Bilious Fevers, fyc. [Nov. 

era preparations, in the treatment of intermittent fevers; this 
view of the general similarity of the pathology of intermittents 
and remittents, suggests the early and liberal use of quinine in 
the latter form, even in the faee of the objection, that the diseased 
condition of some of the organs, (constituting the very differ- 
ence between these two forms) forbids it; regarding this state 
dependent on the original local nervous irritation, it suggests, that 
it is far more prudent to run the risque of increasing the succeed- 
ing paroxysm, than to leave this original focus of irritation unat- 
tempted by this heroic remedy, so likely to reduce it ; for this 
once subdued — the paroxysmal return of fever dependent on it, 
prevented — the disordered -state of the organs may be more safe- 
ly corrected, afterwards, by appropriate remedies. It thus con- 
firms a practice formerly more in vogue here, than at present, 
the value of which was attested by the experience of our prede- 
cessors. 



ARTICLE V. 

Remarks on the use of Quinine in Bilious Fevers. By D. 
Hooke, M. D. 

1st. The instantaneous and certain cure of intermittent and 
remittent bilious fevers, depends upon promptitude. The proper 
remedies should be applied as soon as the attack commences. 
There is no danger except in delay or improper treatment. 

2nd. They are ushered in with lassitude, stretching, aching of 
the bones, chill or ague. For these symptoms, nothing is necessa- 
ry but warm drinks and warm applications ; but when to these, 
there are added, anxiety, restlessness, great distress about the 
stomach, or retelling and vomiting, and inequality of the circula- 



1836.] Remarks on use of Quinine in Bilious Fevers, qc oul 

tion, indicated by great heat on the forehead and stomach and 
little or none at the extremities, then besides warm teas, warm 
applications and frictions, mustard plasters, and these very large, 
should be applied over the stomach, and if the symptoms are 
v ry argent, on the extremities also, and kept on until they pro- 
duce a deep scarlet redness in the skin, which they will usually 
do. in from fifteen to thirty minutes. If this redness disappears 
after they have been removed, they should be reapplied. As 
soon as the redness remains permanent, the danger for that pa- 
roxysm is over, because the circulation has been equalized, and 
the dangerous congestion thereby overcome or removed. In ad- 
dition to the foregoing. I would suggest, in very alarming cases 
of collapse, the extensive use of frictions with red-pepper and 
salt. 

3d. After this cold, comes the hot stage, or what is properly 
called fever. If it be the first paroxysm, and the patient former- 
ly of good health, a dose of castor oil, or if this is not at hand, 
one of calcined magnesia and epsom salts combined, should be 
given to cleanse the stomach and bowels, and aided if necessary 
by injections — one of the best is a table spoonful of salt in a pint 
of warm water. To this course, add diluent and cooling drinks, 
and if the excitement is very great, occasionally bathe the hands, 
face and feet, with cold water, A towel wet with cold water 
may too, be laid over the stomach. If it be a second paroxysm, 
or if the disease be still further advanced, or if the patient la- 
bored previously under some bilious affection, a dose of calomel, 
followed in three or four hours by one of oil, is to be preferred 
to the oil alone. 

4th. When the fever has gone off by perspiration or other- 
wise, quinine, the true remedy for these affections, should be gi- 
ven in one, two or three grain doses, every hour, until at least 
fifteen or twenty grains have been taken, if the patient be an adult. 
It may be given in solution or in pills — in any way, so it is giv- 
en, and that largely. I have in very alarming cases, given it in 
five grain doses every fifteen minutes; and have seen it thus gi- 
ven, even restore to health, those who were supposed to be dying. 

[L/~ No remissions of lever should be suffered to pass without 
the quinine, even if purgatives have been neglected during the 
exacerbation of the fever. C /JQ 

Injections, however, should be used in a case of this kind, as 

46 



362 Remarks on use of Quinine in Bilious Fevers, $c. [Nov . 

an important adjuvant, and also in cases of great irritability of 
the stomach. Sometimes the quinine does not set well on the 
stomach, even after the bowels have been evacuated, in such a 
case a mustard plaster should be applied over that organ. 

5th. The above course may always be pursued, and will 
always cure, if commenced before the disease has continued long 
enough to produce local inflammations ; but when these take 
place, they must be subdued before the quinine would be ad- 
missible. But as there is no necessity for this state of things, if 
the above treatment is pursued, I will not now take room to say 
how it should be remedied, 

6th. Should a remission be so short, that quinine could not be 
given in sufficient quantity to arrest the disease, the cold and 
hot stage should be treated again as above advised — prefering 
calomel as the purgative, and as soon as the remission is again 
apparent, commence with the quinine. Let it only be remem- 
bered, in order to induce every one to give the minutest direction 
all due attention, thct these fevers, which can be thus so easily 
arrested, destroy more human life than any other whatever. 

7th. The quinine does no lasting injury — it sometimes pro- 
duces a ringing in the head, some giddiness, and occasionally a 
little deafness, all which disappear in a short time, generally in a 
day. To compensate for these temporary evils, it cures without 
any waste of flesh or strength, or constitutional energy. This 
ought to he constantly remembered. 

8th. The drinks throughout the attack should be of the mild- 
est kind, such as water, toast water, gruel, chicken water, rice 
water, or the like. Every thing heating and irritating should be 
carefully avoided ; and so also, should all drastic purgatives, 
narcotics and blisters. Drastic purgatives never fail to do mis- 
chief, and narcotics and blisters so seldom, that they should never 
be used in these fevers, except under the advice of an experi- 
enced physician. 

9th. Occasionally, after the fever is cured, the patient con- 
tinues to feel dull and disinclined to action — here the diet should 
be light, and the bowels kept moderately open until these sympr 
fjoms disappear. 



1830J On Hcemorrhoids. 833 

Part II.— REVIEWS AND EXTRACTS. 
Hcemorrhoids. 

We are much pleased with the remarks of Dr. Salmon 
of London, on this important subject. Of all the diseases 
that afflict human nature, there are few more common, attended 
with more suffering, or followed by more disastrous consequen- 
ces, yet there is none oftener neglected, or treated on erroneous 
principles or no principles at all — 'empiric nostrums and patent 
remedies, being the means generally resorted to for relief, until 
too frequently irreparable injury has been sustained. 

" A just consideration of the causes of any disease, (says Dr. Salmon,) will 
be our best guide not only to prevent its occurrence, but likewise as to the 
method of treatment we should adopt for its removal or alleviation ; let us 
therefore briefly inquire into the causes of piles. 

Various as these will be found, they all tend towards the same results ; viz. 
deposition in the cellular tissue, which unites the mucous and muscular tunics 
of the rectum ; distention of the minute vessels of its mucous coat, and mere 
or less enlargement of the hemorrhoidal veins. Piles may therefore be pro- 
duced by any circumstance, constitutional or mechanical, which preternatu- 
rally excites, or mechanically obstructs, the circulation in these particular 
parts. Thus they not uncommonly arise from an injudicious perseverance in 
the use of peculiar or violent purgative medicines, or excessi\ e bodily exer- 
tion, particularly horse exercise ; hence, also, results the prevalence of the 
disease in persons accustomed to a sedentary mode of life, the warmth exci- 
ted from the constant sitting position of the body promoting an inordinate ac- 
tion in the vessels of the lower part of the rectum ; while the want of proper 
exercise induces a torpid and confined state of the bowels, in a great degree 
assisted by a deficiency in the biliary secretion. 

I believe the disease is often caused, or much increased, from the fashiona- 
ble, yet pernicious custom of sitting upon chairs having hair or stuffed seats. 
Persons, especially those whosp occupations are of a sedentary description, 
should accustom themselves to use chairs, the seats of which are composed of 
cane, formed into a net work. 

The soft blue hsemorrhoidal tumor, which may be said to be the true pile, 
will always be found in conjunction with an enlarged, or otherwise diseased 
condition of the liver, which circumstance is physiologically explained, when 
wo consider the immediate connection that exists between the vena porta 
and the hemorrhoidal veins. From this cause, these veins will sometimes 
become distended to so great a degree, as to form tumors of a very consider- 
able size ; and I have seen an instance, in which from extreme enlargement 
of the hemorrhoidal veins, the fore-finger could not be introduced into the 
rectum beyond the first joint ; the patient was likewise the subject of fistula 
in ano. 

Another effect of irritation in the rectum is, that coagulable lymph is from 
time to time thrown out upon the inner coat of the intestine, but more partic- 
ularly in the cellular tissue which connects the mucous and muscular portions 
of the bowel. This deposition organizes and gradually increases, till at last a 
huge mass of superstructure is formed, which is productive of extreme annoy- 
ance and exquisite suffering. 

But another and extremely prevalent cause of the disease will be found in i 



364 On Haemorrhoids. [Nov. 

contracted condition of some part of the rectum, which causes an accumula- 
tion of faeculent matter in the bowel ; this necessarily irritates it, and sooner 
or later produces ulceration of some portion of its mucous surface ; while the 
perpetual straining which accompanies the desire to relieve the bowels, the 
result of the accumulation, injects the minute vessels of the intestine, distends, 
and finally causes them to rupture ; from which sources arises the haemorrhage, 
more or less expeiienced by those who are subject to piles. Now it is not al- 
ways judicious, suddenly to correct this effect, for although it is a diseased 
action, it, not unfrequently, is the mode by which nature relieves herself, and 
it thus, perhaps, .prevents the formation of a more serious disease. 

Dr. Salmon's observations on the treatment of piles, are not 
less philosophical and judicious — as they are too concise for far- 
ther condensation and too valuable for any omissions. We will 
present them to our readers in his own words. 

" This, (the treatment, says Dr. S.) in a great measure, must necessarily 
depend upon the cause from which the disease arises. Should it be connect- 
ed with any hepatic affection, we of course principally direct our efforts to re- 
store the healthy state of the liver